CGMS Poll

[Abby-Dabby-Doo]

I'm going to run this poll and then print it off and send it with Abby's insurance appeal.

Regarding the CGMS

Are you...

[Treysmom]

I am very interested in the CGMS. I have to wait till ins starts paying. I have not gone to my ins and started the process yet. I am waiting for the right moment for us.

[LantusFiend]

I haven't tried for insurance coverage and I'm using the CGMS. I'm going to see if they'll pay for part or all of the next box of sensors, but I'm not going to worry about it either way. I didn't vote.

[moco89]

I voted that my insurance approved CGMS. I have United Healthcare, and they approve the CGMS for anyone with Type 1 Diabetes. The CGMS will become a standard of care, whether or not insurance companies choose to recognize this issue right now. I am pleased that my insurance company is setting the precedent for the rest of the industry, by recognizing the importance of real time availability of blood sugars. The CGMS will improve diabetes control, since with a cgms, you can correct before a high or a low ever occurs. With blood glucose tests/fingersticks, you can only truly correct retroactively.

[Mama2H]

Approved after 1 appeal :)

[valerie k]

united health care as well... no appeals, approval right away. Tho, coverage isnt as great as I would like and we pay way to much out of pocket. Im still grateful tho.

[Rick]

We just purchased a Dexcom CGMS out of pocket, our CDE thought we wouldn't have a chance of insurance approval if we didn't have frequent unrecognized lows or couldn't raise his A1C from 6 to 8. :eek:

[Caydens_Mommy]

We are very intrested in obtaining one but were told they do not cover them for more then 3 days..We will be fighting this in the near future..

[funnygrl]

Insurance approved it on first appeal, but no longer using it.

[Grace]

How about AMBIVALENT regarding CGMS? :p BUT, I could see that changing easily as circumstances change.

[thebestnest5]

We were able to write obtain pre-approval by sending a letter of medical necessity from ped endo, personal letter documenting our reasons for needing CGM, and 6 months of BG logs. Then it was reviewed by a different ped endo to determine if he/she felt there was a true medical necessity in Liv's situation. Liv did not meet all their criteria for "need' but our letter detailed why their criteria was not accurate in her situation.

[Rick]

Insurance approved it on first appeal, but no longer using it.
Which CGMS was approved and why are you no longer using it? :confused:

[funnygrl]

Which CGMS was approved and why are you no longer using it? :confused:
522 RT. No longer using it because I really never got worthwhile information out of it. It just read all over the board and rarely came close to even matching meter readings. Also, many, many error messages and lost sensors.

[wilowndmomof3]

Thanks to all the talk about them on these boards we are really interested in them now. Only problem would be if insurance will cover it or not, we really cannot afford it if insurance doesn't cover it :( CDE told us back in Dec the chances of insurance covering them was really slim, but it doesn't hurt to try now does it.

DS told me last night he thought it would be neat to have. He has been listening to DH and I talk about them the past few weeks.

[dragonfly]

We were able to write obtain pre-approval by sending a letter of medical necessity from ped endo, personal letter documenting our reasons for needing CGM, and 6 months of BG logs. Then it was reviewed by a different ped endo to determine if he/she felt there was a true medical necessity in Liv's situation. Liv did not meet all their criteria for "need' but our letter detailed why their criteria was not accurate in her situation.

What was the "criteria for need"?

[Kaylee's Mommy]

Kaylee uses the MM cgms, we absolutely love it.. insurance does not pay, even after we exhausted all our appeals, they said they would HAVE to once she turned 7 but because she isn't 7, they don't have to so they won't:mad:

there have been so many situation that the CGMS has caught lows that would have turned out to be very dangerous, highs from bad sites that we didn't catch, and lows in the middle of the night, something that Kaylee has NEVER woken up from.

[Kirsten]

How about AMBIVALENT regarding CGMS? :p BUT, I could see that changing easily as circumstances change.

That's me! I am interested in the CGMS, but it needs to be smaller and more accurate before i will take the plunge. Having it on the same site as the pump would also help. I just don't feel like the technology is quite where we need it to be for our toddler.

Kirsten

[Lindy]

denied - but we are fighting in appeals and we are paying out of pocket! The information is too valuable and it's a safety device that I would not want my child to be without!

[hawkeyegirl]

We were approved on the first go-around by our insurance company - BCBS IL HMO.

[thebestnest5]

What was the "criteria for need"?

Insurance "weighted" the below criteria as more likely to be approved; but not necessarily approved.

A1C over 7 (Liv's highest was 5.5)

ER room visits (Liv had none)

Extra hospitalizations (Liv had none)

Number of times person had to use Glucagon (Liv's was zero times)

Was dx'd for at least 6 months (Liv was just over 1 year past dx)

There may have been something about complications? (Liv doesn't have any)

[dvane]

We were denied before I was even finished aksing the question :mad:.

[chocoholicsc]

We were approved w/no appeals needed. However, I'm really having a hard time deciding to try it. I am concerned about the size/insertion process and inaccuracies. Going to ask Endo on Monday what he thinks.

[Abby-Dabby-Doo]

Bumping for the weekend.
Hoping I can get as much info as possible!

PLEASE vote if you haven't, you don't have to post!

THANK YOU!!!:cool:

[fredntan2]

I"d love one for dd, but she has to want it. I'm going to see some at the conference in sept . I'm kind of waiting to see if a smaller /better one comes out.

[musicjunkie]

Fallon doesn't cover it:(

[Abby-Dabby-Doo]

Michelle~ did you vote?

[Adinsmom]

I voted. We will be pursuing a cgm in the fall once the weather cools down and Adin is back on the pod.

BTW: Did you read sixuntilme about her insurance battle to get the cgm?

[cgates]

Bumping it for you, Lanae.
--Charles

[Abby-Dabby-Doo]

I voted. We will be pursuing a cgm in the fall once the weather cools down and Adin is back on the pod.

BTW: Did you read sixuntilme about her insurance battle to get the cgm?

I didn't read her battle, I will have to do so, she's a very good advocate!:cool:


Bumping it for you, Lanae.
--Charles

Thank you Charles, it's good to see you around again! ;)

[dragonblimps_mom]

Amelia was approved first go round by Care First BCBS of MD (PPO) for the Navigator. We don't have it yet. We're still waiting for Care First to sign the agreement with Smiths Medical.

Mary Catherine
Amelia age 10.75, dx T1D 2000, dx CD 2001, dx thyroid 2002