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CGM Users - Please Reply!

Discussion in 'Parents of Children with Type 1' started by Darryl, Aug 6, 2008.

  1. Darryl

    Darryl Approved members

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    I just was notified we were granted a Level 3 appeal with an
    Independent Review Board for our CGM Independence Blue Cross denial.

    For our presentation I would like to include a list of all insurance companies
    that cover all or part of a CGM.

    If your insurance company covers all or part of your CGM, could you please
    reply (or send me a PM) with the type of CGM, the insurance company, type
    of plan, and whether they cover full or partial CGM costs?

    Thanks I really appreciate it...
    Darryl
     
  2. hawkeyegirl

    hawkeyegirl Approved members

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    We have BCBS HMO of Illinois. We use the MM CGMS, and the sensors and transmitters are covered 100%.
     
  3. WestinsMom

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    We have MICHILD (low income children's insurance in Michigan) and they just started covering most of it...it might be 80%. We use MM. MICHILD is run by Blue Cross Blue Shield of Michigan.

    ETA: I think it is 90% after thinking about the numbers.
     
    Last edited: Aug 6, 2008
  4. moco89

    moco89 Approved members

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    United Healthcare PPO-coverage at 90% for receiver, transmitter, and sensors.
    I have a 10% copay.
    I use the Abbott Freestyle Navigator.
     
  5. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    Not using CGM but in your shoes I would call my CGM rep and find out how the insurance reimbursement looks from their end; who's paid, who has recently begun covering etc. That might give a more comprehensive picture.
     
  6. MReinhardt

    MReinhardt Approved members

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    Chell has

    Illinois Medicaid
    approved the MM Guardian in November of 2007
    THEN approved for MM 722 pump with the CGMS February 2008.
    everything covered 100%

    Chell uses the pump with the CGM and we get to keep the MM Guardian.
     
  7. Andrews mom

    Andrews mom Approved members

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    We had BCBS of MN and they covered his. They had stipulations about testing at least 8 times per day but we definitely did that so that wasnt an issue. They were very good about it- they never denied it just would request info from his endo but they were fairly quick.
     
  8. Gwyn

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    Sent you a PM
     
  9. EmmasMom

    EmmasMom Approved members

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    United Healthcare Open Choice PPO,
    covers MM minilink & sensors @ 90%
     
  10. hold48398

    hold48398 Approved members

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    This is us. Our plan is PPO Choice Plus.
     
  11. Mama2H

    Mama2H Approved members

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    Pm Abbydabbydoo she just recently compiled a list using this site, yahoo groups, and one other site of everyone she could find with insurance coverage for the cgms.

    We have first administrators and they covered after 1 appeal.
     
  12. KarenRI

    KarenRI Approved members

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    We have United Health RIte Care/RIte Share. We only need coverage for sensors. Nate received his CGM hardware (722 pump and Minilink transmitter) through the Artificial Pancreas Project at Joslin.

    Good luck!!!
     
  13. KitKat

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    BCBS Indiana covered but we have a $4000.00 cap.
     
  14. Darryl

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    Thanks Sarah... that is a great idea. Now that you mention it, shouldn't the CGM companies keep track of this and have it available? My MM rep has been very good about keeping in touch with me on the appeal, but hasn't provided me with any "ammo" to help with the appeal process other than general guidance.

    I'll ask the rep and let you know what they say. Thanks again.
     
  15. Darryl

    Darryl Approved members

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    Yes, I got that list... but the sources of the companies covering CGM's are not listed, so I'd be a little more confident if I hear from a bunch of people first hand!
     
  16. Darryl

    Darryl Approved members

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    Thanks everyone... this is really helpful. Our L3 appeal is in 14 days.

    If anyone else has an insurance company to include, I'll be checking this thread up until the day of the appeal.
     
  17. sam1nat2

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    we have BCBS of Colorado. Minimed signed a contract with them in May. I called minimed directly and they confirmed this.
    We received our minilink and sensors THEN the denial letter:mad:
    I called today to order more sensors and was told we would have to pay out of pocket. We will be appealing this after our endo apt on Tues which I hope to show how the CGMS drastically lowers his a1c.
     
  18. Mama2H

    Mama2H Approved members

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