We got insurance coverage for Dexcom!!

[rmccully2000]

THANK YOU to Emma's parents for paving the way with United Healthcare. They approved it as out-of-network Medical Supplies on the initial claim. I did not even have to fax information to the predetermination department.

I will go ahead and appeal the out-of-network decision, since there are not any in-network alternatives. It's worth a shot and will be a difference of $300 in deductibles and 90% vs. 70% coinsurance :)

Yippee!! Thanks UHC!!
Becky,
Mom to Mason, 6

[Amy C.]

Congratulations, Becky!

Now has anyone been successful with Blue Cross Blue Shield of Texas? There is no way we can afford a CGMS unless there is substantial insurance coverage.

[rmccully2000]

Congratulations, Becky!

Now has anyone been successful with Blue Cross Blue Shield of Texas? There is no way we can afford a CGMS unless there is substantial insurance coverage.


Thanks Amy!

I don't know of anyone personally, but BCBS was mentioned in a Dexcom presentation a few weeks ago as having approved coverage on a case by case basis. They mentioned hearing from their customers of reimbursement from Cigna, Humana, BCBS, and United Healthcare.

I should note, that I only applied for reimbursement for the sensors. The unit was so inexpensive that I want to save insurance reimbursement for this part in case I want a better one later.

[5miraclez]

How much are you paying with them covering it? Will they cover minimed too?
We had the option of SelectHealth or United Health. We stuck with Selecthealth since that is who we had before but if United Health will cover the Minimed sensors then I may have to change.

[EmmasMom]

That's wonderful Becky! I'm so glad they're covering it!!!:D I'm glad I could be inspiring!!!;) LOL (hopefully many more people will seek coverage too!)

I still don't know the amount they will pay on our claim, we're still waiting for the EOB. I submitted the bill for the transmitter and sensors, but I had already told them that we would pay for the transmitter ourselves, now I wish I hadn't done that!:rolleyes:
Since minimed is in network for united healthcare I'm hoping for 90% coverage like we get on all other durable medical equipment. We shall see!

[rmccully2000]

How much are you paying with them covering it? Will they cover minimed too?
We had the option of SelectHealth or United Health. We stuck with Selecthealth since that is who we had before but if United Health will cover the Minimed sensors then I may have to change.

Right now it will be a $500 deductible, then coinsurance will pay for 70% of the cost of sensors. So I would pay for the first 14 sensors at full price, then each sensor would cost $10 each.

I'm going to appeal for in-netork coverage which would be a $200 deductible (first 6 sensors), then insurance will pay for 90% of sensors (bringing my cost down to $3.5 per sensor).

Becky

[mariano42]

So you had luck with UHC?
Please tell me how you did it, I can't get them to do anything for me right now since MM doesn't have an insurance code.
I keep hearing its possible, but UHC claims it is not!

Glad to hear you had success!

[rmccully2000]

We used a miscellaneous durable medical equipment code (can be used for any cgms system).

Go join this group (http://health.groups.yahoo.com/group/diabetescgms/)and click on the File section on the left menu. There is a folder titled Insurance tips. The codes and descriptions are in there as well as information requested by UHC in initial claim (provider address, tax ID, etc).

I have also posted the EOB from UHC stating the Dexcom sensors are covered as out-of-network. I have just sent in the appeal to have them covered at in-network benefits.


Good luck!
Becky

[payam7777777]

CONGRATULATIONS BECKY.

It's now time to go for the pump.