- advertisement -

Insurance Coverage for CGM

Discussion in 'Insurance Issues' started by Jeff, Apr 2, 2008.

Tags:
  1. Marcy

    Marcy Approved members

    Joined:
    Jun 10, 2008
    Messages:
    5
    Aetna PPO
    Texas
    MM CGM
    For Myself:D

    After showing a log of Bg numbers for 3 months--Testing AT LEAST 4 times a day, as well as mnay readings under 50 during the night
     
  2. jane1218

    jane1218 Approved members

    Joined:
    Jul 8, 2008
    Messages:
    96
    Aetna HMO
    NY
    Minimed
    14 YO

    Denied at first, then reversed after the first appeal.
    We had to prove repetitive hypoglycemia even with multiple glucose checks on a daily basis.
     
  3. taximom2

    taximom2 Approved members

    Joined:
    Nov 14, 2006
    Messages:
    5
    First won on appeal:

    Great West Healthcare PPO
    CO
    MiniMed MiniLink
    Age 11 when approved

    Changed companies and won again:

    BCBS
    TX
    MiniMed MiniLink
     
  4. Colorado4

    Colorado4 New Member

    Joined:
    Jan 7, 2009
    Messages:
    1
    BCBS of Illinois?

    Does anyone have coverage for CGMS with BCBS of Illinois?

    Help is much appreciated.

    Jay

    daughter Julia with type 1.
     
  5. Tricia22

    Tricia22 Approved members

    Joined:
    Jun 30, 2008
    Messages:
    683
    United Healthcare PPO
    Illinois
    Dexcom
    22 years old
    (had this company before the start of the new year, and we were 100% covered through Edgepark DME)

    Also, just switched companies and was told by both the new company AND Dexcom we would have 90% coverage after a deductible is met...

    Anthem BCBS of Illinois
    Illinois
    Dexcom
    22 years old
     
  6. DebbieR

    DebbieR Approved members

    Joined:
    Nov 16, 2007
    Messages:
    120
    GreatWest Healthcare PPO (owned by CIGNA)
    California
    Minimed CGMS
    Two children, ages 11 and 8
     
  7. Budapest

    Budapest Approved members

    Joined:
    Nov 29, 2006
    Messages:
    653
    IMG (International Medical Group - imglobal.com - Not for US citizens living in the US)
    world wide coverage
    MM Guardian
    2.5 years old
     
  8. sammysmom

    sammysmom Approved members

    Joined:
    Oct 30, 2005
    Messages:
    1,635
    HAP (hmo) of Michigan
    Dexcom
    For Sam, 7yrs old. He is the first under age 18 approval.
     
  9. Jacque471

    Jacque471 Approved members

    Joined:
    Nov 7, 2008
    Messages:
    995
    Oxford Health (A Division of UnitedHealth Care)
    California (insurance contracted by parent company in NY though)
    Dexcom 7
    2 years old

    We received prior auth and were told we were covered at 100% after meeting our deductible. However the claims department denied the claim as "not a covered service" and are currenltly investigating and reprocessing claim. Sadly we paid OOP figuring it was towards our deductible and now we have to wait for reimbursement. Ugh!

    ETA** As of today it has been covered under Oxford at 100% after our deductible. They claim it was filed wrong under ?home health? was the reason for the original denial.

    On May 1 we are changing to Great West Healthcare PPO so I am pleased to see they have granted approvals to others, and hope we can continue to get coverage!
     
    Last edited: Mar 24, 2009
  10. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    - CIGNA HMO
    - Virginia
    - Navigator
    - 4-year-old T1 diabetic

    Approval was received after submission of paperwork and LMN from Endo on first submission - 5 business days!
     
  11. ecs1516

    ecs1516 Approved members

    Joined:
    Dec 11, 2007
    Messages:
    7,028
    United Healthcare

    Georgia


    Two diabetic children approved on first request from doctor one week.:D


    11 years old (last year) August 2008
    Navigator

    9 year old September 2008
    Navigator
     
  12. rachabetic

    rachabetic Approved members

    Joined:
    Mar 18, 2008
    Messages:
    577
    Blue Shield HMO
    California
    MM Real Time system
    17 years old

    It took 3 appeals to get approval.
     
    Last edited: Apr 4, 2009
  13. iluvmhp

    iluvmhp Approved members

    Joined:
    Mar 10, 2008
    Messages:
    1,582
    United Healthcare - Florida POS
    10 year old - needed to show lows below 50
    Dexcom 7 plus
    80% coverage
     
  14. AmyMcCracken

    AmyMcCracken Approved members

    Joined:
    Mar 1, 2006
    Messages:
    290
    Aetna - OpenChoice PPO
    California
    Minimed CGMS
    (Minimed had to submit the paperwork to Aetna)
    8 years old
    Had to show lows below 50 - diagnosis code 250.83
     
  15. JohnMom

    JohnMom Approved members

    Joined:
    May 22, 2008
    Messages:
    168
    Kaiser
    Ca.
    Minimed Paradigm Minilink CGM
    Age 9 yo
     
  16. Chippy28

    Chippy28 Approved members

    Joined:
    Sep 24, 2008
    Messages:
    190
    - HAP Solo
    - Michigan
    - Dexcom 7+
    - I am 25

    I have an individual plan through HAP and they covered my CGMS at 100%. No hoops to jump through either!:)
     
  17. HeatherJakesMom

    HeatherJakesMom Approved members

    Joined:
    Oct 10, 2008
    Messages:
    202
    BCBS of Mississippi State Employee Plan
    Dexcom
    10 year old T1 on Animas pump
    Only covered at 60% as it is out of network
    We are waiting for better coverage since our #'s are pretty good.
     
  18. Droz

    Droz Approved members

    Joined:
    Jul 15, 2009
    Messages:
    28
    Badger Care and the CGM

    I Have been contacting my congress person. There is actually a department that deals directly with diabetes and other health issues. This department deals directly with medical things that are not covered with state insurance. The more people who do this the sooner it will be covered. I even had my rep from medtronic mini med send in reports on people who have been on the cgm and what their A1c was before and after. This is what the board looks at when determining if a product or medication should be covered by state insurance. So please write, call, email your congress person. There is a need for this device to be covered. I am in WI, so I am sure every state and county are different.
     
  19. Jordansmom

    Jordansmom Approved members

    Joined:
    Aug 23, 2008
    Messages:
    2,172
    Aetna
    Employer is in Illinois
    Dexcom
    Age 13
     
  20. Shannon Payne

    Shannon Payne Approved members

    Joined:
    Jul 26, 2009
    Messages:
    5
    CGM Insurance Coverage

    Insurance Co: SISCO (covered 90%)
    State: Iowa
    Sensor: Dexcom
    Haley (15) Dx: 2-2009

    I had minimal problems with my insurance company and the CGM. Haley's Physician told us right away that with her A1C at 5.5 and her BG numbers within normal limits that the insurance would most likely deny it. He is even surprised with this decision but thankful that they are beginning to see the benefits of this more and more.
     
    Last edited: Sep 11, 2009

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