CGMS approved by insurance; MiniMed dragging their feet!

[semperwife]

As the title states our CGMS was finally approved through Tricare. It should have been approved on Monday (the 6th) but the wrong code was entered and I had to spend an entire day Tuesday calling doctors offices and the insurance company until it all got worked out. I finally got the official approval/ authorization code on Wednesday evening on Brandon's birthday (the 8th). Great birthday present huh!! I call MiniMed who told me they couldn't do anything until they got the hard copy of the authorization.

Called the insurance company back who told me they could fax it to MM first thing Thursday morning. Called MM back and got the direct fax to the saleslady who was trying to put my order through.

Thursday morning comes around and I call Tricare, get them to fax the hard copy of the authorization to MM, and then called MM to make sure it went through. The lady at MM then informed me that the codes weren't correct so she had to send it to her supervisor who would get in touch with Tricare and the MM insurance rep for California and call me back. I explained that the codes are the correct codes. I also explained that these are the codes that Tricare said had to be used in order for the payment to be processed. She informed me that the codes are not there. They use E1399 not S1030. I stated that we had just had the doctors office redo everything using the S1030 codes because that is what the insurance company states has been assigned to purchase Continuous Glucose Monitoring Systems. She tells me that they still have to contact the insurance company because they have not been made aware of any of these codes being issued. They were not to be issued until January 08. Tracy then asked me why we wanted the Guardian, why did the doctor write for the CGMS and why did we want it right away. What kind of question is that. I told her unexplained higher A1C's that don't correlate to meter readings, hypo unawareness, the fact that he is a diabetic and I want 288 readings not 12, the fact that he has been doing this for almost 10 years and his fingers look bad, the fact that my doctor agrees that it will benefit him. She said oh okay, well that is what we needed. I wait all day and nothing. No word from MM. I finally get a call back at 5:30 pm only to tell me they were not able to get any answers but they will call me first thing in the morning on Friday.

Friday morning I am informed that the order has finally gone through and Amanda would be calling me to finalize the order. Amanda calls me around 11am and says that we need to discuss payments and financing. I said my insurance company authorized this and I was told it would be covered under the same coverage as my insulin pump supplies. She said "oh you have an authorization??" I said yes I have an authorization on file. Tracy should have given that to you. She said well I am going to have to get that from her and touch base with your insurance company. I said she has already been in contact with my insurance company. They did that yesterday and this morning, verifying that my insurance company approved the CGMS not a blood glucose meter. She said well I have to talk to them anyways to find out how extensive your coverage is. 2 hours go by and nothing so I call her back and she informs me she got the file from Tracy and then went to lunch. She just picked up my file to work on it and she will call me back. She stated that she has to talk to the insurance companies because some are giving authorizations and then still not paying because they said that it is experimental and they didn't realize how expensive it would be so MM now has to call all insurance companies and double check to make sure they are authorizing the CGMS. I said that has already been done by Tracy. She said she had to do it as well because she does the orders and Tracy is a salesperson. She then says that she has to contact the doctors office to get a letter of medical necessity. I said the insurance company has the doctors letter of medical necessity on file. She said oh well we need a copy of it as well. I said why? She said to prove you need it. I said obviously my son needs it or the doctor wouldn't have written a script for it. The insurance company has the script, the letter and the 2 months of clinical data I sent them. At this point I told her I was very frustrated because MM has had my order on hold for 2 days now because they don't trust my insurance company and the codes. I told them they are making me feel like they don't want my business. I had explained that I wanted to get the order in right away so we had a few weeks learning it before we sent him off to school and I would love to have it by the 19th to mark our 10 year D anniversary in a special way. She said she understood and would try to get things taken care of so we could have the
guardian and the sensors by next Friday. Oh yeah the guardian is in stock but there are no sensors to be had right now, they are looking at 3-4 more days.
I told them they need to speed up on the sensors as most military families are being informed of the fact that it is covered now and they are going to get bombarded with requests from military families. She said they are handmade, it takes time. She also told me that I have to have a trainer come out to my house and show me everything about the guardian even though I went through the tutorial online and the fact that I have the 712. She said the trainer has to do the startup because the sensors are so much.

I didn't hear anything back from them Friday, Saturday or Sunday. I feel like I did nothing all week except fight doctor's office nurses, the insurance company, and MM. I am tired of getting the runaround. What happened to here is your script, here is your letter, here is your order. Why is it so difficult now? I figured once the insurance company approved it then it should get easy.

Monday I got a phone call saying that she would be working on it all day, that it was going into single case negotiations. I said what does that mean and how does that affect when I am going to get the guardian. She said that means Brandon will have a contract between Tricare and Minimed to ensure that he gets his guardian and all his sensors covered as long as he needs them. This is the first step since they are no longer sending Californians to a 3rd party for the CGMS. Apparently the 3rd party just bought it from MM and they fought with Tricare and got payments. Now they are changing it and it is just going to take time to get everything set up.

I feel like they have the authorization, they should go ahead and send us the guardian and the sensors.



So our good news is it is authorized.it is somewhat ordered but not in hand
and no way of knowing when we will get it.

[semperwife]

I guess my persistence paid off. The guardian will be here today but they don't know if someone can train us today or it might be Monday.

The problem is that we have caught 20 lows this week without this device, we have cut back on Lantus, we are still having lows. The doctor said it could be from a stomach virus. He has had it twice since the 5th of August. They told me not to put a sensor in until they trained me or they wouldn't cover failed sensors. I don't want to wait until Monday

So we will see. I was also told to call on Monday and order the package of 10 sensors. Then mark my calendar and call in about 20 days or so to order the next package of 10. This way I don't run out. Does that sound right? How do you guys usually handle the reorder?

[WestinsMom]

I would wait until you see how long they tend to last for your son, or how long you are comfortable letting him wear it. Then remember that they seem to always be backordered!

[semperwife]

So even though the insurance company is covering one every 3 days it is not best to change it every 3 days?

She said it is best to go ahead and order the 10 pack right away and then guage everything off of that... ususally the last week of the month just reorder.

It finally got here today. It was suppose to be here by 10:30 am and it got delivered at 445 pm. They said the truck broke down. Should I be concerned about the sensors...there was still frozen gel packs around it.

Brandy

[semperwife]

Got the guardian yesterday!! Can't hook him up yet.