CIGNA and CGMS

[BrendaK]

Okay, just for kicks today I called CIGNA, my insurance company and asked if they covered the CGMS with Minimed. The rep I spoke to said they will cover it at 100% if we have a letter of medical necessity. I said WHAT -- are you SURE -- and YES she was sure. But, I'm not sure she knew exactly what I was talking about.....

So I'm calling the minimed rep today to have her check it out, too. If they truly cover everything at 100% then we are IN. Sorry, Cozmo, you've been good to us, but not fast enough with that Navigator!!!

[bkfkmc]

Please keep me updated. I have been waiting on Cigna since December. I need some new ammunition! :D

[EmmasMom]

That would be fantastic! :D I'll keep my fingers crossed that she was right!!

[bkfkmc]

BrendaK-

After reading your post today I called to check on our status since it has been a couple of weeks since my last inquiry:rolleyes: . I was told to send in some more information, but this time I got a MAYBE out of them!!!!!:D Yeah! It's not a yes, but it is a step in the right direction. It is definitely better than where I started- with a no. Anyway, I am excited at the possibility and have to get busy getting what I need together. Anyway, the lady from Cigna that has been helping me has been great. I think I'll send her flowers if we ever get an absolute yes!!!:p

[BrendaK]

Well, I called them a second time yesterday just to see if I got the same answer and I did. They said if I want it in writing, I need to send a predetermination request in and they would make the "final" decision and send me something back in writing. And then I asked if the first person I talked to was crazy or knew what she was talking about and the second rep said that yes, she DID know what she was talking about.

I'm still not holding my breath until I get something in writing, but it's looking promising.

Today's task will be to have the endo fax that stuff in for me, which I'm pretty sure they will. Then I will probably have to wait until after spring break next week to find anything out.

[MLH]

We have Aetna and I too am trying to get some coverage for the cgms. I spent 1 1/2 hrs on the phone last week just getting bounced around from dept to dept trying to get a case manager involved.

Finally, I took matters into my own hands--I researched the name and # of the CEO of Aetna. I contacted to headquarters and insisted on speaking to him. Every time they asked me a ? I answered and then asked to speak to the CEO. The operator put me through to a SUPERVISOR :eek: :D By the next day I was on the phone with a case manager with a medical background!!! She was very helpful. She said I should have an answer inside a week. She explained to me the appeals process and my rights. I am cautiously optimistic. I will keep you posted!

Nothing is going to stand in my way of this!

Michele
mom of AGH 9 dx'd 5, pump and
LMH 6, nonDi

[MLH]

WE WERE APPROVED!!!!!

I am sooooooo excited:D :D :D !!!!

Michele
mom of AGH 9, dx'd 5 pumper
LMH 6 nonD

[BrendaK]

CONGRATS!!!! It seems like all of a sudden those insurance companies are finally getting it!!! When do you start?

[MLH]

Thanks! I have to wait for the letter which I should have by early next week. But I have an auth.code, which is key. We switch to the 522 on Tues. (from Cozmo). I would like to get adjusted to that and then add the cgms. So hopefully within the next month. :)

The nurse from Aetna told me that one reason they approved it because it is still cheaper than 1 visit to the ICU for a severe low. I think all these insurance companies are going to have to come up with plans for this. There is no way moms of type 1's are going to sit back and accept an insurance company who will not cover this! We are a dedicated and passionate bunch!:D

Michele
mom of AGH 9 dx'd 5 pumper
and LMH 6 nonD