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For those with For those with CGMS Coverage - DME or Diabetes Supplies?

Discussion in 'Parents of Children with Type 1' started by pdxmom, Mar 30, 2009.

  1. pdxmom

    pdxmom Approved members

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    I was thrilled that our coverage for sensors was finally approved after we switched to new insurance. The sensors are on their way, however, the insurance company does not know if they will be covered under DME or diabetes supplies. They "think" it's DME. I'm having a hard time understanding why sensors would be DME but the rest of her supplies (pump supplies, strips, etc) are not. Plus, my DME has a $250 deductible, whereas our supplies dont (just a 20% copay, which I dont pay since we use APlus -thank god!).

    For those of you with CGMS coverage, does it fall under DME?

    Why oh why is insurance so hard to understand!!!!!! And even if I try to understand it...they still dont!

    Thanks for your help!
     
  2. Jacque471

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    On our current insurance (a division of United Healtcare) the sensors are not considered DME.

    We are changing insurance on May 1 and I really hope they are covered on it at all. I also hope if they are that they are not DME as there is a $10,000 lifetime cap on DME and we will blow through that fast. Ugh. I hate insurance.
     
  3. Nancy in VA

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    Ours are DME which I'm happy about because we have 100% coverage
     
  4. lotsoftots

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    ours is a DME also..which makes it coverd at 100% also
     
  5. hawkeyegirl

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    I think ours are DME, but to be honest, I'm not sure. They're 100% covered, as are pump supplies.
     
  6. ecs1516

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    Us too. We may change from United to something else. I thought our sensors were DME right now, I don't know. I just have to meet the deductible just like pump supplies.
     
  7. ecs1516

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    Which insurance do you have?
     
  8. pdxmom

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    We have Providence Health Plan (Portland, OR). Supposedly they have never billed for CGMS, so we are getting the go around because we are the guinea pig.
     
  9. ecs1516

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    At least they are paying. That is a blessing!
     
  10. pdxmom

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    Absolutely! And I have to keep that in mind when I get frustrated with "how" they are paying. My previous insurance covered ALL diabetes supplies (pump, CGMS, strips, etc) with full coverage. So having new coverage that isn't as progressive is an adjustment. But you are right, I've got to count my blessings!
     
  11. jbsmom

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    reply to cgms coverage

    ours was dme, but mid January the company changed insurance companies and now we have to go threw the certification again for everything including the pump supplies. They replied that my dd's does not qualify for the cgm or pump based on last years a1cs and bgs. My reply to them is last years numbers are good because she was (is** on the pump and using the cgm. Hopefully they will get this straight soon. Be sure to check into the continuation of coverage, this should help with any concerns. I also hate dealing with insurance companies.
     
  12. jules12

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    Ours is dme and we have to meet our deductible first and then it covers 80 percent. We have a 5,000 cap per year.
     

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