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Thomas radcliffe's Blog (2)

Medicaid Based Coverage in Florida

As of this last week we have been successful in obtaining coverage for a CGM (Dexcom) in Florida in a Medicaid Based HMO. The private provider was Healthease (Wellcare).

A Clinical Guideline Policy now exists (HS-138).

http://www.wellcare.com/WCAssets/corporate/assets/HS138_Continuous_Glucose_Monitoring.pdf




Added by thomas radcliffe on March 23, 2010 at 2:51pm — 2 Comments

CGM Medicaid Florida

Hi,

I am the Permanent Legal Guardian of a 9 year old type 1. She has had a prescription for a CGM for months now and her insurance, which is a Medicaid based HMO has denied coverage.



We have been through a grievance, first level appeal, second level appeal, an administrative reconsideration of the second level appeal, and are now beginning the State Administrative Fair Hearing process before a hearing officer.



And we are likely to lose. We have done all of the… Continue

Added by thomas radcliffe on October 17, 2009 at 9:00pm — 2 Comments

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