CGM approved by Medica ... BUT ...

[Rachel]

... I found out the the date of coverage begins ONE FLIPPIN DAY after I bought the unit.

I had assumed that the insurance coverage would take months of letter writing so after a weekend of crazy numbers, I jumped in and bought it. The Medica rep told me that it would be no problem ... just to have the provider call with the ONE DAY extension on the date(s) of coverage. Well, just heard from the clinic that Medica told them no, that I now have to do an official appeal to get the date changed. One day.

Guess I shouldn't have gloated about not having to use the appeal letter I had already drafted for the coverage. :o

Did I mention that it was ONE DAY off?

First call in the am is to our Medtronic insurance rep. I was just so happy to think this was done ... bleh.

[EmmasMom]

Did you get help from the MM insurance people? I never thought to talk to them about it. Hmmm

We're still having a HUGE turnaround time on getting our sensors paid for because we pay first , then file a claim, then UHC "forgets" that they've agreed to cover this thing, or loses the claim I sent, etc. It's all very frustrating!!!
If MM would just bill them I think it would fix the problem. Maybe I'll ask for an insurance specialist when I call MM tomorrow about reordering.

[Rachel]

Our MM rep put us in contact with a "Pump Specialist" who focused on insurance issues when we started with process to get the CGM approved.

She actually had us do things a bit backwards ... she told me to write the letter to the insurance, with the prescription and letter of medical necessity. I did all that but when I followed up a few weeks later, was told by the Medica person that all that was needed to start the process was to have the doctor send the letter of medical necessity directly to Medica. That seemed to do the trick.

So either the process changed in the past month or the MM pump/insurance woman didn't know things worked with Medica. Either way, she is my first call to try to get this resolved quickly.

Bummer to hear about the reimbursement problems. I remember you had them at first but I assumed that once things got into the system it would run through like the pump supplies. I hope having MM bill insurance will help ... Good luck!

[hrermgr]

It's nice to have insurance, but.....yeah, things get messed up big time. We were surprised when we found out our insurance was even covering the MiniLink. MM told us twice they were covering it under "pharmacy"--because of the sensors. Not really what we wanted to hear since we've met our out of pocket max for durable medical goods/doctor appts but not for pharmacy. When my husband called the insurance company to be sure it would be covered, the customer service person had to talk with a couple of different levels of management and came back that insurance will cover the MiniLink as durable medical goods! Just what we wanted in the first place!

Keep asking and keep pushing. Insurance is just beginning to realize the benefits of the sensor so we'll see more and more insurance companies.