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.
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.
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.
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."
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.
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.
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.
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???
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@example.org if you can reach people. I know that with BCBSTX that's how they work...all the addresses are email@example.com. I bet that others do that too....
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.
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