They finally paid for our transmitter!!!

[EmmasMom]

:D I just looked on line and saw that our claim for the $999 transmitter and sensors was finally processed on Friday!! Yippee!!!!!

We'll be getting reimbursed at 70%, and I'm not sure why, it should be 90%, but either way I'm happy. I'll fight over the 20% later, for now I'm just thrilled that they finally paid it!! :D

[bkfkmc]

Will you legally adopt my son?:D He can still live with me just be carried on your insurance!!! Ha! ha!:p

Seriously, I am thrilled for you!

[rickst29]

I'll be a very well-behaved 'little' boy :D Well, maybe.

does your insurance maybe cover 'children' up to age of, say, sixty? :cwds:

[bkfkmc]

If either you or Becky (Mason's mom) envisioned having large families, I am sure you would have plenty of willing "children" on this forum!

I am waiting on my appeal because there was a mix up and the insurance company reviewed my initial letter without the Endo's letter of Medical Necessity. They are currently reviewing the information again and I am awaiting their determination after reviewing "all" of the initial claim. I am not holding my breath...but I can always hope that we will have a better outcome this time. If not, I will get myself ready for the appeal (thanks to Becky's great information to get me started).

[EmmasMom]

I would adopt you all if I could! Unfortunately I think UHC might drop us if we add one more diabetic to our family policy!;)

Just keep plugging away with the insurance fight. I was told "no way" for months before I got it approved, and it took more months to actually get it paid, but it was worth the fight!

[Sam's mom]

I am very interested in the CGMS and I have called my insurance company (Blue Cross) asking about coverage. No one there seems to know anything, they tell me it looks like it would be covered but they would need a procedure code, which they don't have. They tell me to call Minimed because that is where they would get the code. I have spoken with the Minimed rep who has also not been that helpful, as she tells me to call the insurance company.

For those of you who have won insurance coverage, how did you go about it? I am thinking I will probably just need to buy it, put a claim in to be denied, and then fight. Any insight would be greatly appreciated!

[EmmasMom]

The only way to get it covered right now is on a "case by case basis". There are no codes, so the insurance company has to use a miscellaneous equipment code.
MM can't assign a code, since it's apparently Medicaid/Medicare that comes up with these codes after something is considered standard, and non-"experimental".

I paid upfront, and then submitted my claim to my insurance. I started with the predetermination department. I sent them a letter of medical necessity and Rx from our endo, a letter from me explaining why she needed it, a cost comparison spread sheet showing long term savings if we use fewer test strips, and all the product info from MM. There are some good clinical trial results out now that could be included as well.

We were denied twice, but eventually won. I faxed the info in often, sometimes several times a week, and spent many hours on the phone with anyone who would listen to me!!:rolleyes: It was a frustrating process, but very worthwhile!

[thebestnest5]

I am so happy for you. Hopefully, this will cause a domino effect for all CGMS to be covered. :D :D :cwds: :cwds: