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CGMS and Cigna - Any advice?

Discussion in 'Parents of Children with Type 1' started by Lorraine, Aug 4, 2008.

  1. Lorraine

    Lorraine Approved members

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    Hello all,

    Caleb's next endo appt is next Tuesday. I plan on making the request for the Navigator. We have Cigna. I want to come as prepared as I can for the Medical Necessity application in hopes of getting approved the first time around, if that's possible.

    I've made a specific schedule of his BGs listing the day's low and high by day and how many BG checks we do. This goes back about 2 months and shows several days where there are low lows and high highs.

    I've also typed up bullet points like - hypo unawareness, erratic BGs at night requiring BG checks every two hours, increased food sensitivity, etc.

    Is there any other advice anyone could offer?

    Lorraine
     
  2. Seans Mom

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    Have you called the insurance company and asked about coverage?
     
  3. Nancy in VA

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    From everything I understand with CIGNA, they approve the CGMS as long as you have a letter of medical necessity from the Dr.
     
  4. Lorraine

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    Haven't called directly. There official policy is not exactly encouraging as there is a lot of reference to "experimental" and such. I was looking for the real low-down on what people have experienced and any pointers if there had been any difficulty.

    Thanks!
    Lo
     
  5. Nancy in VA

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    I asked them a year ago when I was first looking into pumping and they said they covered it under DME

    They are listed in the pinned post of insurance companies that cover CGMS
     
  6. Lorraine

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    Thanks Nancy - that's interesting. I think I'm apprehensive because a little over a year ago they were denying Omnipod's because their policy was not to cover CGMS - they erroneously thought that's what the Omnipod was. I think it was specifically written in their policy. I was happy to see their policy language had changed so much since then, but it still seemed to leave lots of room for denial.

    Lo
     
  7. mom2Hanna

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    I'll be curious to see what happens with you. In our cigna policy it says it considers CGM experimental and does not cover them. Our policy also says 6 months of shot therapy before they will approve a pump so we are holding the pump paperwork until 8/18 just to make sure it isn't denied for that. CGM is the next thing I want for my daughter but our dr recommended we learn one piece of new technology at a time and I think its good advice.
     
  8. Nancy in VA

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    That must be specifically the coverage your employer chose.

    We got our pump approval before 6 months after diagnosis - it was about 4 1/2 months! We even got them to override the "3 educational appointments a year" and approve all of our pump training and follow-up since we had already used all of our education with her diagnois.
     
  9. CDoyle1013

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    Something wrong when health care is tied to profits

    Just have a very uneasy gut feeling when a person's health care is tied to the profits of a health insurance company. My insurer is also CIGNA and I write a ton of appeals and get them to overturn 100%. You have got to keep trying....with data, reason, facts, doctor's statements, etc. and then request a hearing before their docs who deny your requests. Then threaten to sue under "bad faith" insurance issues. An insurance company will never come out on top of my daughter's health....never.


    Cigna 2Q profit jumps 37 percent
    The Associated Press
    Article Launched: 08/01/2008 04:49:39 AM MDT


    NEW YORK—Philadelphia-based health insurer Cigna says its second-quarter profit rose 37 percent on a jump in premiums and fees as the company's acquisition of Great West Healthcare boosted membership.
    Profit rose to $272 million, or 97 cents per share, from profit of $198 million, or 68 cents per share, during the same period a year ago. Excluding one-time gains and charges, the company earned $1.08 per share in the latest quarter.

    Revenue rose 11 percent to $4.86 billion from $4.38 billion.

    The results easily beat the average estimates of analysts polled by Thomson Financial, who forecast profit of 97 cents per share on revenue of $4.76 billion.

    Cigna expects adjusted profit between $4.05 and $4.25 for the full year, while analysts expect $4.17 per share.
     
  10. selketine

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    Is this the company that recently agreed to pay for a CGMS but as a rental (or something odd)? You also had to have a few readings below 50 and some other things. I cannot find the posts about it though.
     
  11. sam1nat2

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    I think cigna stands for "Call In Get No Answer"
    Seriously, I wish you the best. don't give up!

    I think that a year ago these devices were just getting approved for peds, hopefully enough time has passed and they have seen how beneficial they are!!
     
  12. mom2Hanna

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    LOL, guess who the employer is, Cigna! Yes my dh works there. We probably could have gotten the pump sooner but my daughter wasn't ready and at this point rather then risk having it denied and approved on appeal, we can wait the 2 wks to submit it.

    They are as a company very proactive towards diabetes and the JDRF. They are the major sponser of our local walk.
     
  13. Lorraine

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    Our policy is the same and was the same last year too regarding the pump - had to wait 6 months. However we were approved for the pump after less than 4 months on shots. I don't think you need to wait at all. I don't think it will be a problem. I had thought I would be in for a battle last year but it was a non-issue. I got that call from Insulet saying 100% covered and I almost fell over. I believe their "official policy" is something they point to when they need to, but practically policies are different. We have been very happy with Cigna's coverage and I've heard a few people having no problems with CGMS too. So there is hope!
     
  14. Seans Mom

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    There is a difference in policies though. We have Cigna POS, my husband is a state worker. We have been told many times since our son's diagnosis, that our policy through the state is better than other Cigna POS policies. I have never had a problem getting someone on the phone, and usually no problem w/ getting answers. On the website, looking at the policy for getting a pump, we thought also that we had to wait 6 months and show necessity. However, we went ahead and sent a little early and was told by Animas that we have great insurance, we didn't even need pre-approval, just the drs. orders. So I thought calling Cigna to find out the specifics of what YOUR policy are would be a good way to go. I'm not interested in the cgms right now, maybe when they have the pediatric version, so I don't know if it's covered on our policy or not, or how easy or hard it would be to get it covered.
     

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