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For those of you will Anthem! GOOD NEWS!

Discussion in 'Insurance Issues' started by kkuncl, Apr 22, 2008.

  1. kkuncl

    kkuncl Approved members

    Mar 17, 2008
    I just received this email from our local Medtronic Rep!!

    Great News!!!
    Anthem just announced a policy for REAL-Time CGM. This is incredible news because they have been the most difficult to deal with regarding this product. We feel like many of the other insurance companies will follow suit with this precedent.

    Here is the Anthem CGM criteria:

    Long-term use of continuous interstitial glucose monitoring devices as an adjunct to standard care is considered medically necessary in the care of the following:
    * Patients with type 1 diabetes who have experienced recurrent episodes of severe hypoglycemia with blood glucose less than 50mg/dL; or
    * Patients with type 1 diabetes who are pregnant, during the course of their pregnancy;
    When all the following criteria are met:
    * Inadequate glycemic control despite compliance with frequent self-monitoring (at least four times per day) and including fasting hyperglycemia (>150 mg/dl) or recurring hypoglycemia (<50 mg/dl). This poor control is in spite of compliance with multiple alterations in self monitoring and insulin administration regimens to optimize care; and
    * Insulin injections are required 3 or more times per day or an insulin pump is used for maintenance of blood sugar control; and
    Four or more finger sticks are required per day.

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