My appeal got overturned for CGM coverage!!!!!

[krstn9@yahoo.com]

I finally got the letter and the call from Blue Cross that they are reimbursing me for the CGM I purchased, all past sensors, and also future purchases!!! Needless to say, I am thrilled and hope that this makes it easier for someone else doing the same thing next.

It was not easy and I spent a lot of time fighting which I shouldn't have had to do. I don't think I did anything differently than anyone else on this board. My letters did include: proof of hypoglycemia unawareness, case studies of CGM success with nightime hypoglycemia, financial analysis of why it is in Blue Cross's best interest to cover compared to another hospital stay, doctor script, and my last letter included "the fear of god" if they didn't cover it (reporting to ADA, AMA, DOI, etc.) There is also a bill in California that was designed just for the purpose of the rising costs of diabetes. Guess who was one of the sponsors of that bill? You got it.. Blue Cross. I don't know if all this did it or BC is just so large that I got lost in the bureocracy of the company.

It takes a lot of time, but if you can do it... keep fighting.

[hrermgr]

Congratulations on your success! Hard work does pay off:D!

[AmyMcCracken]

Kristin - Congratulations! I've been appealing the denial for CGMS for my daughter.

There is also a bill in California that was designed just for the purpose of the rising costs of diabetes.

Where can I find information about this bill? Maybe it will help me with my fight.

[KitKat]

I am fighting BCBS also. Could you contact me so I can maybe benifit from your win?

Thank you

[EmmasMom]

Congrats!!! That's fabulous news!:D

[anbond]

We have just started our journey with the insurance company for my son's CGM. Could some one help with the letter of medical necessity? Where can I get ideas on letters others have written for the CGM.;)

[vettechmomof2]

We have just started our journey with the insurance company for my son's CGM. Could some one help with the letter of medical necessity? Where can I get ideas on letters others have written for the CGM.;)

Your doctor or the sensor company should already have one written up. So, I would check with them first.
Good luck, I am in the battle as well.
Allene

[Lizzy1964]

Kristen, how long did it take you to get coverage and reimbursment for the CGMS? I am getting trained and hooked up on the 15th. The Dexcom 7 trainer told me that in Michigan, BCBS usually denies it twice, then for the third appeal it goes in front of an external board made up of doctors and then it is usually approved. So, I am really hoping. She also said that it usually takes about six months. I have hypo unawareness. unexplaned highs and live alone so I'm hoping they will get it through quickly. Congratulations on your approval!!

[krstn9@yahoo.com]

Yes, It took about 7 months with 4 appeals. When I finally got someone assigned to my case when it was overturned, they said that it should have been overturned a long time ago... whatever that means :) She also said that it should have gone to a pediatric endocronologist for us.

I don't think that there is any magic paperwork to give them other than to keep perserving until they overturn the claim. Good luck and thank you for the wishes. Everyone keep the fight going.... kristin