Does your insurance pay for your CGMS?

[Treysmom]

If you don't mind me asking. Does your insurance pay for your CGMS? I'm starting to think more about this. This is just curiosty on my part:)

[Kaylee's Mommy]

we pay out of pocket but I fought long and hard with our insurance company first.. Kaylee is 4.5years old.. They said that we put up a good fight and proved our point and they DO see a need for it.. they had an independent dr. review it and he even recommented it but because its not FDA approved for her age they won't pay.. they said as soon as it IS FDA approved OR she turns 7 they will start covering it.. the guy said I don't need to send anymore paper work or anything, just call him and say she's 7 or that its FDA approved and they set everything up.. so for a little over 2 years we need to pay for these out of pocket..

[EmmasMom]

Yes!:) United Healthcare has been amazingly good for all of our diabetes related stuff. I did have to fight and beg and jump through hoops for many months before they covered the sensors, but eventually it worked.

Just FYI; Minimed insurance specialists will badger your insurance company for you. I haven't had to call UHC myself for about 6 months, once I got UHC to agree to pay for sensors the first time MM was willing to take over from there.:D

On a related note, a big-shot with UHC recently had a child dx'd with D. I heard they put him on a CGMS right away and that may influence the coverage.

[Treysmom]

We have Blue Cross Blue Shield. I will be talking to our endo about it soon. I would like to get the ball rolling. I just don't think I can swing it w/o help from insurance @ this time.


Thanks For Replying!!

[Mama Belle]

No clue. We haven't tried yet. But I see much insurance company badgering in our future. Although I've heard rumors that some folks with Aetna are getting coverage (that's what we have now, so who knows). CIGNA was a nightmare with other stuff, so I'm glad we aren't using them anymore.

[OSUMom]

We're just beginning the fight. We'll see how it goes with BCBS of Delaware. 20 years of fighting medical insurance for things over the years is wearing me out. My current battle is over hand surgery this summer and seeing 3 doctors over it.

Anyway, hoping CGM is covered. I know once insurance will acknowledge receipt of the doctor's letter, MM will begin their surge as well like Amy said. They're great.

[MaggieM]

I have heard that our insurance has historically covered it. I am in the process of trying to get one now. My request has been in the works for several weeks. However, I just learned that my husband's company is changing insurance carriers effective 1/1/08. I just had to sit through hours of documents to pick our new coverage. So I think the reason the current insurance company is dragging their feet is the obvious. We are loosing this customer in 4 weeks so why should we do this? I guess I will have to begin the process all over again in January with the new carrier. :(

[bkfkmc]

I have fought the fight with Cigna and have not been successful. For this reason, we are switching to an HMO in January. I am not thrilled about switching to an HMO, but it is United Healthcare. I figured that a HMO from United Healthcare has to be better than an POS from Cigna. We'll see. I'll be starting the fight again in January.

[thebestnest5]

We were approved for coverage after submitting a lengthy letter and sending 6 months of BG logs, indicating why and where a sensor would be needed and after lots of prayers.

We have an HMO. I believe prayers softened the hearts of those I talked to. I called and a rep listened to what it was like for a type 1 diabetic child. He did some checking and found that just days before I called a policy changed and I could try for a pre-authorization.

The nurse who first reviewd Liv's pre-auth. was so empathetic. She told me that she really wanted the Ped. Endo who reviewed Liv's case to approve it. She talked to me to find more ways of helping present Liv's case for approval. I couldn't believe how helpful she was!:cwds: Liv did not meet the criteria set forth for approval. She had never used glucagon, she had never had an ER/hospital visit, her A1c was not over 7...
The nurse told me that she didn't want these things to 'count against' Liv. The nurse was very aware that all of our BG checks were the reason Liv had not experienced some of the above. We talked about hypo-unawareness and quality of life when you can see glucose trending. We talked about avoiding long term complications, which can be very costly.

[JenFur]

Nope. :( Blue Sheild.

[zimbie45]

Still fighting.. We just got denied for being " experimental" ... AND THE fight is on!!!

[jilmarie]

Nope, cigna :(

[Mom2Madi]

Yes - Tri-Care Southern Region covers everything with a $9.00 co-pay from me for the unit and the sensors.

[SuperGracie]

Yes, Harvard Pilgrim has been a God send for us. Didn't have to fight, beg or plead. We sent Grace's insurance information to the CGM company which happens to be Minimed, and they did the rest. HP also covered the Omnipod for her!!! I wish you all could have this coverage. I am fortunate that I've never had to fight the insurance fights that some of you have and I can't imagine having to do that in addition to the every day stress of dealing with D. Kudos to all of you for being vigilant and so very strong.

[Debbie]

We have United Healthcare and they are paying!!:D Thank you, Amy, for going there before me!!

[KeltonsMom]

Yes - Tri-Care Southern Region covers everything with a $9.00 co-pay from me for the unit and the sensors.
I am in the Western Region and they will not cover it for Kelton, however, they may cover it for me..Weird...Or it may be because of age?

[dvane]

We have Regence Blueshield and we were denied before I even finished asking about it. They consider it experimental:mad:.

[Budapest]

Check out http://forums.childrenwithdiabetes.com/showthread.php?t=4437

Although it was not updated since the summer it is a pretty long list.

When it works, the CGM is great.

[rickst29]

and they didn't even force me through through one round of the 'denial-appeal' game. They simply left my claims "pending" until the charging codes were announced, are are now covering under those codes.

[Jacob'sDad]

Jacob just started on the Animas pump and I don't think they have CGMS yet. However they say that when they do, it will be a more advanced system than what is currently available. My thinking from the start was that it wasn't worth fighting for at this time. When we chose Animas the fact that they didn't have CGMS wasn't a big concern. I felt that by the time Animas had CGMS in place it would be FDA approved and insurance would cover it without a fight.

[Budapest]

Somewhat OT:

Jacob just started on the Animas pump and I don't think they have CGMS yet.
They don't indeed, but you can use the standalone Minimed Guardian system with any pump or even without a pump.

However they say that when they do, it will be a more advanced system than what is currently available.

This might be years from now.:( We used to wait for the FreeStyle Navigator but gave up waiting 6 months ago when the Minilink came out from Minimed.

[Lizzy731]

We don't have one but we checked and they do pay if Endo prescribes it. My husband works for the state (school district) and the coverage is quite good. This may the reason....

[coni1523]

we have blue cross blue shield of texas. They are paying for ours. Minus 10 percent. I know that bcbs is paying for them now. I was told by Nov. 1,2007 they were going to. Yeah!!!!!! I would try. I love the CGMS it helps alot. It will keep you on your toes though. My son's goes off alot....


Connie

[kevin@diabetech.net]

It sure would be great if each of your factual responses were made available at CGMSCentral.com Jeff has a link to this reimbursement resource on the CWD home page so you know it's worthwhile. Unfortunately, this info inside of a forum thread isn't nearly as useable as it would be as part of the definitive insurance carrier/plan specific page at CGMSCentral.com where everyone can create and edit for the community's benefit.

[MaggieM]

We just requested the CGMS in the beginning of November. Medtronic was working on it with our insurance carrier. I found out the end of November that the insurance would be changing effective 1/1/08. I figured that since we would be loosing our current company - they wouldn't even consider giving us the system. Then - through a holiday miracle, I received a phone call last night that our system is being shipped out today. This will help with getting the new insurance company to cover the supplies as well (or so I am told by my husband's benefits office - they said anything covered by the old is automatically picked up by the new agency).

We should be hooked up soon!