CGM Anti-Denial Campaign Website

All you need to fight for CGM coverage.

Gina Capone's Comments

Comment Wall (61 comments)

At 2:29am on August 15, 2008, Mama Belle, aka Heidi said…
Thanks for the invite, Gina!
At 2:54am on August 15, 2008, Peter Barrett said…
Hey Gina. This is Peter. I just got an email from you. I have no idea how you got my name. I'm 55 and have hadType 1 for 40 years. I just started pumping two years ago, and now I'm ready for CGM. I have a great doc who's written a strong letter of support that I've not yet submitted. I'm expecting a fight from my insurer, Anthem / BC / BS of California. So, I'm delighted to see that you and others are working on this on the national level. You go girl. And I'll keep you posted as to what results I get from Anthem California.
At 3:12am on August 15, 2008, Mary C. said…
Hi Gina, Carefirst BC/BS of MD covered the Navigator CGMS for my 11yr daughter. I have the PPO plan and they covered 100%. We just started this past Monday and we LOVE it! It's like opening a window on diabetes so you can really see what's happening.
At 6:27am on August 15, 2008, Marshy said…
Horizon BCBS of NJ is listed as a company providing coverage; as of this posting this is no longer true.
At 8:50am on August 15, 2008, Linda Kallish said…
Hi Gina,
Why isn't Medicare on the list, or am I missing it? Thanks, Linda
At 8:59am on August 15, 2008, Stacey Nagel said…
Gina,
Add GHI ( Group Health Inc) of NY to the list..
they're approvong on a case by case basis..
Ours miraculously came thru in just under 2 weeks...
At 10:07am on August 15, 2008, Cynthia said…
I haven't even tried to get a CGM because I'm struggling to keep up financially with my pump. My insurance coverage - through CareFirst in DC - isn't great.
At 3:26pm on August 15, 2008, Tonya said…
Have you received coverage for the CGMS yet?
At 3:32pm on August 15, 2008, Tonya said…
I have Aetna PPO as well, and I think their policy is the same for here as it is in New York. Do you have a copy of the clinical policies? Aetna changed it in July to make CGMS medically necessary for type ones who have hypoglycemic episodes 4 or more times a day.
At 3:45pm on August 15, 2008, Tonya said…
Sorry, that was supposed to be "test 4x a day" I am at work, and some one was talking to me while I was typing. Should proof read!
At 3:48pm on August 15, 2008, Tonya said…
CPB 0070 part VIII:

"Continuous Glucose Monitoring Devices :

Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons' blood glucose levels over a three-day (72-hour) period, medically necessary for persons with type 1 diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:

1. repeated hypo- and hyperglycemia at the same time each day; or
2. hypoglycemia unawareness.

No more than two CGMS monitoring periods are considered medically necessary within a 12-month period.
Aetna considers the long-term use of continuous glucose monitoring devices medically necessary as an adjunct to fingerstick testing of blood glucose in persons with type 1 diabetes who have had recurrent episodes of severe hypoglycemia (blood glucose less than 50mg/dL) despite appropriate modifications in insulin regimen and compliance with frequent self-monitoring (at least four fingersticks per day). Long-term use of continuous glucose monitoring devices are considered experimental and investigational for all other indications."
At 3:57pm on August 15, 2008, Amy said…
Gina,
When my insurance company denied me, I did an external third party appeal through the New York State Board of Insurance. Whatever the third party decides is binding. So now my insurance company has to cover me.
At 1:26am on August 16, 2008, Laurie said…
Hi Gina - yes, I'm out of town right now but I'll get information up soon....hopefully I'll have a chance later this weekend, if not by early next week

thanks!
At 8:46am on August 16, 2008, Doris Ann Dickerson said…
Hey Gina,
Please tell me where to start on this????????? I really belive this will help me out but I get really tired of trying when the answer is always no!
At 6:28pm on August 16, 2008, Robert (Wes) Ridgeway Jr said…
I am in Missouri covered by Cigna PPO, the only way, I got coverage was through Edgepark whom Cigna will pay, (even though Edgepark requires an up front payment first) alot of hassle considering Edgepark orders, than has the product shipped directly from Medtronic.
At 9:36am on August 19, 2008, Deb Pisciotta said…
I live in Massachusetts, my son was covered by United Healthcare Passport Connect Harvard Pilgrim Health Care. It's pseudo Harvard Pilgrim Health Care. They just sent us a letter saying they would be ceasing coverage as of March 2009 for all CGMS related products.
At 4:49pm on August 19, 2008, Laurie said…
Hi Gina! What are the plans as far as reaching medical directors and the petition? I wonder if it would be beneficial to send the petition directly to the medical directors since they make the policy decisions. Or, do they need to be hit with separate correspondence? There appears to be enough patient feedback per the petition comments to contact them with information thus if that would help. Just started thinking about this and thought it may be good to work on???
At 4:54pm on August 19, 2008, Laurie said…
try google....I found quite a bit of info (addresses/phone #'s) on many that way...I put some of the links with the aetna post. May not be able to find emails but regular mail can work.

Since most of these are practicing doctors they have contact info through various directory and provider listings...
At 6:52pm on August 19, 2008, Laurie said…
you'd think that more doc's would have email. Mine doesn't and told me that was by choice!

I'd see if you try formulas like firstname.lastname@company.com if you can reach people. I know that with BCBSTX that's how they work...all the addresses are first.last@bcbstx.com. I bet that others do that too....
At 12:55pm on August 21, 2008, Phil Lerner said…
I need to write a letter to a state Representative in RI explaining what a CGM is and why they are so necessary. Do you have a sample letter I can use? I am sure they have no clue as to what Diabetes is or what a CGM does.

I hope the Representative will introduce legislation requiring coverage.

Thanks for your help.

You need to be a member of CGM Anti-Denial Campaign Website to add comments!

Join CGM Anti-Denial Campaign Website

© 2017   Created by Gina Capone.   Powered by

Badges  |  Report an Issue  |  Terms of Service