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Thread: Insurance Companies Covering CGMS

  1. #21

    Default Anthem BC of CA

    Anthem BC of California baught my Navigator in 12/08 but I am an adult Type 1 if that makes any difference. Don't know if they cover them for children.

    Judi in MI

  2. #22
    Join Date
    Dec 2006
    Location
    Southeast of disorder
    Posts
    14,141

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    Quote Originally Posted by MaryMom View Post
    I see that Tricare Prime is listed.

    They have recently changed and are VERY difficult to get a CGMS.
    I didn't find that at all.

    We're using US Family version of tricare prime but not only did they approve the Revel for us before our Cozmo was out of warranty they approved the CGMS with absolutely no issues and for 100% coverage.

  3. #23
    Join Date
    May 2010
    Location
    Hillsborough NC
    Posts
    171

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    We have Tricare Prime remote (I think that's the name). My husband is an activated reservist. They are a secondary payer for us. Our primary would not pay for the Dexcom but Tricare preauthorized it right away. No I have to pay upfront and then jump through the hoops to get reimbursed but it hasn't been too terrible.
    Brenda Mc
    Mom to
    Seth age 14, dx 3-22-10 (age 10)pumping green Ping Dexcom 6-9-10
    Jenna age 11 nonD

  4. #24

    Default

    BCBS TX PPO just came through on our Dexcom 7 Plus.
    Our deductible was met--they paid 80%.
    Mom to 18yr old dd, dx 7/2009
    Animas Ping 2/2010
    T:SLIM 12/2014
    Dexcom 7 Plus 9/2010
    Dexcom G4 11/2012
    Dx PCOS 5/2012
    Metformin



    The mind that opens to a new idea never returns to its original size.

    Albert Einstein

  5. #25
    Join Date
    Dec 2006
    Location
    Southeast of disorder
    Posts
    14,141

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    Quote Originally Posted by BrendaMc View Post
    We have Tricare Prime remote (I think that's the name). My husband is an activated reservist. They are a secondary payer for us. Our primary would not pay for the Dexcom but Tricare preauthorized it right away. No I have to pay upfront and then jump through the hoops to get reimbursed but it hasn't been too terrible.
    Just a warning, it seems after the first 6 months are up tricare may need your dr to provide an additional authorization. It has held up my latest batch of sensors. Happened to a friend in the south Tricare region too. (she's active Navy, we're active National Guard) So just keep your eye on it 6 months from now.

  6. #26

    Default

    In response to TriCare coverage.

    We were initially denied coverage. Then after much faxing of reports, letters etc, they approved her for 72 hours!!! We received the start up kit which was the transmitter, receiver and some sensors. Clearly, this got us through a month. During this time we were able to note that she was going low more frequently than we thought.

    We have learned that our daughter has hypo unawareness. She recently was unconcious and then seizures - BG was 25. 11:30 at night, we heard her Dexcom alarming, we went in and could not wake her. So, we tested her and learned she was 25. We tested again to make sure and it was 25 again. As I was getting the glucagon ready, my husband called 911 when he noticed some twitching and the start of a seizure. After all of this, Tricare approved her for 90 days with the Dexcom. At the end of the 90 days, we will have to re-apply to get a pre-authorization.

    If she had a pump that was integrated with a CGMS, it would have been easier. The managed care person said that since she had OmniPod that was not integrated with a CGMS, it was more difficult to receive approval.

    Perhaps those of you who have had no problem getting this coverage through TriCare could list the types of pumps your children have. It could be helpful to someone.

    I'm happy to hear that not everyone has to go through the same hassle that I have in order to have a CGMS for my daughter.
    Mary

    Homeschooling Mom to:
    13 yo daughter, diagnosed 10-6-2009, Pumping with Omnipod since Feb 22, 2010, Dexcom since Feb 25, 2010
    12 yo twin sons, not diabetic

  7. #27
    Join Date
    Dec 2006
    Location
    Southeast of disorder
    Posts
    14,141

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    Quote Originally Posted by MaryMom View Post
    If she had a pump that was integrated with a CGMS, it would have been easier. The managed care person said that since she had OmniPod that was not integrated with a CGMS, it was more difficult to receive approval.

    Perhaps those of you who have had no problem getting this coverage through TriCare could list the types of pumps your children have. It could be helpful to someone.

    I'm happy to hear that not everyone has to go through the same hassle that I have in order to have a CGMS for my daughter.
    actually, we have the MM with the integrated CGM and initially had no problem but like I said above, after the initial 6 months it's been a nightmare. We have finally gotten approval again, but tricare has fully messed up by faxing the paperwork to the wrong people etc. It's been actually the worst experience I've had with tricare in all the time we've had it.

  8. #28
    Join Date
    May 2010
    Location
    Hillsborough NC
    Posts
    171

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    We use the Animas Ping and the Dexcom. Tricare prime remote picked it up quickly for us after our primary insurance denied it. Now, I will say, I've been having to pay upfront and then file a claim with Tricare to get the money back. It hasn't been the easiest thing to do. I've now been told that Edgepark Medical should be filing the claim for me.
    Brenda Mc
    Mom to
    Seth age 14, dx 3-22-10 (age 10)pumping green Ping Dexcom 6-9-10
    Jenna age 11 nonD

  9. #29
    Join Date
    Nov 2009
    Location
    Champaign, IL
    Posts
    12

    Angry CGM denied by BCBS of IL

    Anyone out there get coverage for a CGM with BCBS of IL? My 2 year-old keeps getting denied by BCBS of IL. SO frustrating! I filed a complaint with the IL Dept. of Insurance and I need everything I can get my hands on to prove my case! Thx
    Last edited by ACrawford; 11-13-2010 at 09:39 AM. Reason: mis-spelling

  10. #30
    Join Date
    Oct 2007
    Location
    Johnson City, TN
    Posts
    2,279

    Default

    Seans been using the Dexcom 7+ for over 2 yrs. now. Initially we were approved with Cigna, no problems and quick approval 100 % coverage.
    Our insurance changed to BCBST (Tennessee) on Jan. 1, 2011. Since we now have a deductible and coinsurance on DME, I've used surplus to get by hoping they would last till the beginning of next year, however they didn't and I had to begin the process of getting new sensors with BCBST.
    After waiting 2 wks to hear anything and Dexcom stating they had contacted them 3 times and knew nothing, I called the insurance company myself to see what the hold up was.
    I was told the problem is not with pre-authorization but pre-determination, meaning they were trying to determine whether the service is in network or out of network. The difference being double the deductible and out of pocket maximum and 40% coinsurance instead of 10%.
    Apparently BCBS has recently changed it's process and has decided that you have to have a distributor in your state who can bill insurance for the product. Unfortunately for those of us in TN, and probably many other states, Dexcom has no in state distributor for us. I'm in the process of requesting in-network benefits be applied anyway. In the meantime we've paid out of pocket for a months supply of sensors and hope that if we are approved we can have the amount applied to our deductible.

    Just wanted to give a heads up to anyone with BCBS. Dexcom bills from CA, Edgepark bills from Ohio. Dexcom did say they had distributors in a "few states" but did not identify those states to me.
    Barb, Mom to:
    Sean, 10
    dxd 8-21-07
    Pumping w/ Animas 2020 since 3-04-08
    Dexcom 7+ since 09-09-09

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