maddiesdad
11-06-2008, 01:41 PM
I am posting this to get your device. Back in August, my daughter's endocrinologist filled out paperwork prescribing the Navigator. This was the standard paperwork abbott uses.
Once that was submitted ( again back in August ), Abbott started doing whatever they do and requested some additional paperwork from the Dr's office. Apparantly, the Dr's office drug their feet on this, but that documentation was completed in october.
Abbott then sent off our paperwork to Smiths-Medical.
This morning I called abbott to get status and they conferenced in Smiths Medical. It turns out our insurance, Premera of Washington State, has not contracted with Smiths Medical. Dead end. I spoke with an unbelievably nice lady at Smiths who gave me a lot of background on how the whole process works and she gave me cash pricing for the device and sensors as well.
( FYI -- 937.50 for startup kit and 337.50 a month for sensors through Smiths )
So now....I called abbott back and asked them to find a supplier that Premera of Wa is contracted with and they have told me that Apria is the one. Looking at April, they have a division called Star Medical that does diabetic supplies, but I can find no mention of the navigator on their product list.
If you've read this far, thank you...please keep reading and if you have insight into my questions below, I'd appreciate it....
1) Does anyone have their Navigator supplied through Apria ( Star Medical )? I'd like to confirm they actually do this rather than wait a week and call back and find out they don't.
2) For those of you who pay out of pocket, is the Smiths-Medical cost reasonable...can I do better than that?
3) For those who have bought the device and then later attempted to get coverage for sensors, have you had success?
4) Any other advice for moving this along would be helpful.
Based on Premera of WA's medical policy, it appears that this request will be denied on the basis of the fact my daughter is not a truck driver.
"Policy Guidelines" Link (https://www.premera.com/stellent/groups/public/documents/medicalpolicy/dynwat;14717_62789792_2312.pdf)
Individual case review may be indicated when the purchase of this device is requested for those individuals at risk of injury due to proven episodes of hypoglycemia unawareness especially those individuals employed in potentially hazardous occupations such as firefighters, loggers, truck drivers and etc.
My company has final say on what our medical plan covers once items have been appealed twice and I'm confident I can get this covered, but I am beginning to think a cure is more likely for Diabetes before I get through this whole process!
It seems like if I don't call people once a week, nothing moves....nothing moves from the dr's office, abbott, or anyone else.
Has this been everyone's experience?!??!?!?!?!
Once that was submitted ( again back in August ), Abbott started doing whatever they do and requested some additional paperwork from the Dr's office. Apparantly, the Dr's office drug their feet on this, but that documentation was completed in october.
Abbott then sent off our paperwork to Smiths-Medical.
This morning I called abbott to get status and they conferenced in Smiths Medical. It turns out our insurance, Premera of Washington State, has not contracted with Smiths Medical. Dead end. I spoke with an unbelievably nice lady at Smiths who gave me a lot of background on how the whole process works and she gave me cash pricing for the device and sensors as well.
( FYI -- 937.50 for startup kit and 337.50 a month for sensors through Smiths )
So now....I called abbott back and asked them to find a supplier that Premera of Wa is contracted with and they have told me that Apria is the one. Looking at April, they have a division called Star Medical that does diabetic supplies, but I can find no mention of the navigator on their product list.
If you've read this far, thank you...please keep reading and if you have insight into my questions below, I'd appreciate it....
1) Does anyone have their Navigator supplied through Apria ( Star Medical )? I'd like to confirm they actually do this rather than wait a week and call back and find out they don't.
2) For those of you who pay out of pocket, is the Smiths-Medical cost reasonable...can I do better than that?
3) For those who have bought the device and then later attempted to get coverage for sensors, have you had success?
4) Any other advice for moving this along would be helpful.
Based on Premera of WA's medical policy, it appears that this request will be denied on the basis of the fact my daughter is not a truck driver.
"Policy Guidelines" Link (https://www.premera.com/stellent/groups/public/documents/medicalpolicy/dynwat;14717_62789792_2312.pdf)
Individual case review may be indicated when the purchase of this device is requested for those individuals at risk of injury due to proven episodes of hypoglycemia unawareness especially those individuals employed in potentially hazardous occupations such as firefighters, loggers, truck drivers and etc.
My company has final say on what our medical plan covers once items have been appealed twice and I'm confident I can get this covered, but I am beginning to think a cure is more likely for Diabetes before I get through this whole process!
It seems like if I don't call people once a week, nothing moves....nothing moves from the dr's office, abbott, or anyone else.
Has this been everyone's experience?!??!?!?!?!