Gina,
Have you heard anything about Health Net of California? I am going to get the ball rolling with my daughter's endo next week to get her a CGM. Diabetes Camp told us to get appealing and eventually we'll get it as long as we produce the nubmers. Any input or information?
Thanks!
Gina, I am happy to say that I got a letter from my insurance today, Regence BlueShield, and they have authorized me for the Dexcom Seven Plus! This was a total surprise to me, as they denied me about 1.5 years ago for the Dex Seven, so I have been paying out of pocket all this time. Dexcom filed all the paperwork, along with my doctor, and I didn't have to really do anything. I'm not sure yet at what %, but something is better than nothing! Keep up the good work Gina:)
Hi Gina,
This site rocks! It is so dumb the battle in getting CGMS coverage. It took me almost a year and an appeal with political pressure and I got Tufts Health Plan in MA to cover it. Of course, on a regular basis, my claims are denied and I don't find out until there is an adverse action (like my entire account at Minimed is put on hold). Every time I mount a full blown campaign and get it resolved. It is so worth the fight.
Jessica
I have been fighting BCBS of RI for more than 2 years with no luck at all despite numerous appeals. Two weeks ago Minimed called me and said BCBS of RI was now approving CGMs. They sent my doc a preprinted form, he signed it and today my CGM arrived. I can't believe it. All good things come to those who wait. Gina, I wish you all the best in what must be very difficult times.
I have Blue Shield of California - HMO health plan for California State Employees. My health plan paid 100% of the pump, CGMS and sensors to date. No appeal process was needed. My endocrinologist documented my hypoglycemic episodes needing assistance, especially at night. I've had the CMGS almost three months adn am looking forward to my first A1c with it.
My insurance is covering my CGMS. I have never had a problem. My insurance company is Empire Blue Cross Blue Shield. I have had some hypoglycemic episodes which have proved to be life threatening. The CGMS helps out tremendously.
Hi Gina! Thanks for all the great work you are doing! My insurance is HealthNet. I kind of figure these guys will be the (second-to) last ones on the boat (I saw somewhere they were rated second worst in a survey), but I am still keeping my fingers crossed.
I know I might be asking the obvious, but did you site their updated clinical policy bulletin, that was posted this July?
http://www.aetna.com/cpb/medical/data/1_99/0070.html
When they say their reason is that cgms is experimental they are not following their own clinical policy. When I wrote my appeal I simply addressed the reasons they denied the coverage. I sent iron clad documentation that supported why their denial was in error. If you need anything let me know.
By the way, I received a letter today that said they were not paying. I will send in a copy of the letter they sent me that said it was. Either they are keeping the post office in business or keeping people employed by having a whole dept to support this run around!!! ha ha ha
I got Blue Cross Blue Shield of New York to OK! CGM with the following codes--some of which you have:
Medtronic pump E0784, Reservoir A4232, Infusion Set A4231, Sensors A9276, Transmitor A9277, Alcohol Pads A5199, Receiver A9278.
My diabetes doctor also gave the diagnoses of "Asymptomatic of Hypoglycemic" (without ANY symptoms of a low blood sugar) and Juvenilte Brittle Diabetes
BCBS is covering the pump 100% and the CGM 90% and demanding a co-pay every three months of49.00.
Hopes this helps someone!!
Regarding Laurie's comments about those with good control needing CGM...I agree totally. A couple of thoughts on the topic:
I was actually spooked about posting about my insurance company - the reason being that if they changed their policy I would be screwed...I dislike the fact insurance companies know so much about me anyway...my big-brother mindset said they could make the connection between my postings about one time special consideration for coverage and reneg on my coverage.
Those of us with "good control" deserve access to CGM technology too. The definition of good control changes over time. What was considered good control 20 years ago is now obsolete. The acceleration in med tech means obsolescence comes faster and faster. Gimme technology and give it to me NOW!
My employer-provided health insurance is through United Health Care. My Dexcom Seven supplies are covered at 85%. I had to appeal through my employer advocate to get special dispensation for "in-network" coverage. The logic being that there were no in-network providers of CGM. This was the logic established by my employer advocate with UHC. I had paid for my original CGM moitor and supplies at 60% out of network for a year before getting the appeal in place.
The front page said to let you know if an insurance provider covers it that is not listed. My current insurance CIGNA is not, but my previous insurance HealthPartners (based in Minnesota) does cover Minimed CGM.
Thanks, Gina, for getting such a web site going. I think it's great. These insurance companies need to realize that all of us as persons with diabetes need this technology and until we get it, we won't be quitting or backing down anytime soon. I will fight this all the way to the top and then I will ask if I can stand before the board that decides why I can't get the CGMS and tell them personally a few of my incidents. Wonder if that would change anyone's mind!!!
Established in the summer of 2002, the Center for Biotechnology and Genomic Medicine (CBGM) at the Medical College of Georgia (MCG) was developed to promote interdisciplinary and translational research in Biotechnology and Genomic Medicine with the…
Medtronic, Inc. (NYSE: MDT), based in Minneapolis, Minnesota[2], is the world's largest medical technology company and is included in the list of Fortune 500 companies. Medtronic company was founded in 1949 in a garage in northeast Minneapolis by Ea…
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 lev…
All you need to fight for CGM coverage.
Gina Capone's Comments
Comment Wall (53 comments)
You need to be a member of CGM Anti-Denial Campaign Website to add comments!
Join this Ning Network
My insurance company is BC/BS of California. We have the PPO policy.
Good luck.
Have you heard anything about Health Net of California? I am going to get the ball rolling with my daughter's endo next week to get her a CGM. Diabetes Camp told us to get appealing and eventually we'll get it as long as we produce the nubmers. Any input or information?
Thanks!
This site rocks! It is so dumb the battle in getting CGMS coverage. It took me almost a year and an appeal with political pressure and I got Tufts Health Plan in MA to cover it. Of course, on a regular basis, my claims are denied and I don't find out until there is an adverse action (like my entire account at Minimed is put on hold). Every time I mount a full blown campaign and get it resolved. It is so worth the fight.
Jessica
http://www.aetna.com/cpb/medical/data/1_99/0070.html
When they say their reason is that cgms is experimental they are not following their own clinical policy. When I wrote my appeal I simply addressed the reasons they denied the coverage. I sent iron clad documentation that supported why their denial was in error. If you need anything let me know.
By the way, I received a letter today that said they were not paying. I will send in a copy of the letter they sent me that said it was. Either they are keeping the post office in business or keeping people employed by having a whole dept to support this run around!!! ha ha ha
Medtronic pump E0784, Reservoir A4232, Infusion Set A4231, Sensors A9276, Transmitor A9277, Alcohol Pads A5199, Receiver A9278.
My diabetes doctor also gave the diagnoses of "Asymptomatic of Hypoglycemic" (without ANY symptoms of a low blood sugar) and Juvenilte Brittle Diabetes
BCBS is covering the pump 100% and the CGM 90% and demanding a co-pay every three months of49.00.
Hopes this helps someone!!
I was actually spooked about posting about my insurance company - the reason being that if they changed their policy I would be screwed...I dislike the fact insurance companies know so much about me anyway...my big-brother mindset said they could make the connection between my postings about one time special consideration for coverage and reneg on my coverage.
Those of us with "good control" deserve access to CGM technology too. The definition of good control changes over time. What was considered good control 20 years ago is now obsolete. The acceleration in med tech means obsolescence comes faster and faster. Gimme technology and give it to me NOW!
Welcome to
CGM Anti-Denial Campaign Website
Sign Up
or Sign In
About
Members
Blog Posts
treatment with coverage
Posted by Cindy Fallsen on December 9, 2009 at 2:44pm
Help needed
Posted by thomas radcliffe on October 17, 2009 at 9:04pm
Recently got HealthNet to reverse their denials and cover Dexcom CGM for our six year old son
Posted by Ron Anderson on September 22, 2009 at 11:04am
Tricare Prime denied CGM because child under 7...
Posted by Kelly Houck on August 11, 2009 at 7:21am
TRICARE and Navigator sensors
Posted by Marion J. Edge on May 21, 2009 at 8:00pm
Latest Activity
© 2009 Created by Gina Capone on Ning. Create a Ning Network!
Badges | Report an Issue | Privacy | Terms of Service