- advertisement -

A new rumor: Aetna will flip (and start covering MM CGMS) in 90 days

Discussion in 'Insurance Issues' started by rickst29, Feb 29, 2008.

  1. rickst29

    rickst29 Approved members

    Joined:
    Jun 2, 2006
    Messages:
    578
    Rmour about Aetna (regarding MM CGMS) DENIED by MM personnel.

    See below, original text was:
    Aw, I was kinda sad to hear of this before I blasted them all to heck (it would have been fun. :D:D) I don't know if the pt. which I've been working with wants to continue her battle for coverage sooner, or just wait for the possible policy change. (The word came from MM regional mgr who visited her Endo, and was relayed to her by an office person whom I *know* to be very careful about telling only the truth.)

    But too *me*, it's just a second hand rumor-- and even if I had spoken directly with this MM "bigsohot", it ain't REALLY done until it's done, things can happen. I've suggested that she continue her current battle, and not let the time limits on her current appeal expire.

    Upon pressing for official confirmation from Minimed, that same regional mgr. said that it was a mistake, they have no such agreement coming. :( But he did offer to link us up with a specific appeal review person who has been favorable in the past....
     
    Last edited: Mar 3, 2008
  2. WestinsMom

    WestinsMom Approved members

    Joined:
    Mar 27, 2007
    Messages:
    3,137
    When I *hear* things like that from MM, I automatically think they are just pushing for sales, like buy it and you can get reimbursed, why wait? Just my two cents. It would be good news for Aetna people and maybe help other insurance get their head out of their butts, but I am not holding my breath :)
     
  3. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    Well, we may just have to start mentally getting ready for the CGMS then!! We have Aetna and do not have to pay a dime for a new pump. If they cover CGMS like they cover the pump and it wouldn't cost us anything, we may just have to look into that! Thanks for the update!!!
     
  4. Brensdad

    Brensdad Approved members

    Joined:
    Dec 27, 2005
    Messages:
    2,383
    I think many are covering them now that there are finally billing codes. United covered mine no questions asked.
     
  5. Rick_L

    Rick_L Approved members

    Joined:
    Jul 11, 2007
    Messages:
    85
    I was really hoping this would be true. I have had enough of Aetna and their stupid ways!!!

    Listen to this. I called last week to check on the status of our second appeal that was mailed the end of Jan. They told me that they hadn't looked at it because no one pulled it from the incoming mail:mad: So the person told me they would pull the letter and pass it on to the appeals department. Fastforward one week. I call them back to make sure my last phone call was completed as expected. This person proceeds to tell me that the appeals dept has looked at my letter, but stated no new information was given? WTH?? When I sent the reply they wanted me to include the orginal denial letter, of course that was on top!!! They didn't even read the other 3 pages:mad:

    So now if anyone sends something to Aetna, not only do you need to call and make sure they process your response, but you have to tell them to read the entire document:rolleyes:

    This has been so frustrating. I guess that's what they want you to do is give up, but I'm not:p
     
  6. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    How do I find out if Aetna starts to cover CGMS? Do I have to check w/Minimed or with Aetna customer service? I don't want to have my doctor write a prescription and go through with the paperwork until I know Aetna is covering it. Whenever I talk to customer service reps, they usually don't know what a CGMS is and I don't trust their answers. So how do you find out the REAL answer??
     
  7. WestinsMom

    WestinsMom Approved members

    Joined:
    Mar 27, 2007
    Messages:
    3,137
    I would assume the MM people would know, but then I don't trust them either. I guess you could call and ask them but don't let them do what they did before and start paperwork for a new pump until you know for sure on the cgms! :)
     
  8. T1Spouse&Proud

    T1Spouse&Proud Approved members

    Joined:
    Mar 25, 2008
    Messages:
    119
    I started the whole "do you cover CGM" battle with Aetna in CA today, they said with my plan I have no Deductible for DME, but as with all DME they only cover 50% (suck) and they would cover the CGM if the provider was a preferred one. So tomorrow I start the calls to see if any of the companies are preferred providers. Woo hoo, it's a start.
     
  9. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    I started the phone calls yesterday, too. Aetna's customer service said, of course, we cover the CGM for 3 days :confused: I explained to her they are using language in their policy for the OLD CGM, not the new stuff. Even with the new codes, they still have the old language.

    Then I called Minimed and they don't know either.

    So I basically have to start the paperwork to get one before I will find out a true answer.

    We have an endo appointment in a week, so I'm going to talk to them about it then...

    Just wish I could get a straight answer :rolleyes:
     
  10. T1Spouse&Proud

    T1Spouse&Proud Approved members

    Joined:
    Mar 25, 2008
    Messages:
    119
    That's not bad, when I called the first time they told me we can give you a free glucometer. I said no it's a CGM, I was put on hold while she had to find out what I was talking about, got "disconnected" after 20 min.
    Call 2: I get offered another free glucometer, I tell the lady again no it's CGM, she says well as long it's a preferred provider. So I will update you all on who the preferred providers are in CA that also have CGMs.
     
  11. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    The person I talked to actually knew what I was talking about -- and when I gave her the billing codes, she was able to pull up on her computer Aetna's "policy" about CGM's -- that is where they talk about approving it for only 3 days.

    I think we've pretty much made the decision to switch to the Minimed pump, though. Carson's Cozmo warranty expires in January, so I'd like to get the ball rolling to see what we can do -- I'd like to learn the new pump and CGMS over the summer so I can be comfortable teaching the school how to use it at the start of the new school year.

    Minimed wasn't sure if I could get a new pump since the Cozmo is still under warranty (even though Aetna is a new insurance for us and they said they would cover it :confused:)

    Too much run-around on the phone. I guess we just have to make a decision, go with it, and see what happens!!
     
  12. Paige's Dad

    Paige's Dad Approved members

    Joined:
    Apr 7, 2007
    Messages:
    32

    They only approve them for 3 days because that is what the FDA has approved them for. We get at least 10 days out of our 3 day sensors.
     
  13. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    It's only 3 days a YEAR :confused:
     
  14. Paige's Dad

    Paige's Dad Approved members

    Joined:
    Apr 7, 2007
    Messages:
    32
    What a crock. Ask them if your child is only suppose to have diabetes for 3 days per year. :rolleyes:
     
  15. BrendaK

    BrendaK Neonatal Diabetes Registry

    Joined:
    Oct 29, 2005
    Messages:
    3,835
    Thank you Westinsmom for emailing me this link

    http://http://tudiabetes.com/forum/topic/show?id=583967%3ATopic%3A118793

    Aetna Approves CGM Coverage
    Posted by Mollie on March 31, 2008 at 11:55am in Continuous Glucose Monitoring (CGM)

    View Discussions

    Aetna PPO---Approved my CGM---first appeal @ 90% coverage

    --I sent 2 letters from my Endo---I typed both endo letters(basically copied from the sample letters that Dexcom provided), emailed them to my dr and let her fill in the diagnosis code(which I had researched and suggested her to use 250.83--- which is something like “Diabetes mellitus with other specified manifestations Type I uncontrolled” ) --- which if they needed elaboration on, she was prepared to write an additional letter about hypoglycemia unawareness related to my specific case.
    --sent a personal letter describing my specific need
    --sent an excel spreadsheet - 4 months worth of color coded with highs and lows marked in different colors. (see attached---if you want to feel better about your control, look at this)
    ---sent average meter tests per day relating to A1C results.
    A1C 7.3% testing 4 times per day
    A1C 6.6% testing 6-10 times per day
    A1C 6.0% and 6.1%, using CGM testing 3-4 times per day
    ---sent documentation of Pre-CGM A1C results and Post-CGM A1C results


    First Appeal approval is unheard of in past experience...maybe Aetna is finally coming around.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice