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Insurance Coverage for CGM

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

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  1. Seans Mom

    Seans Mom Approved members

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    We have the Cigna State of TN POS plan and was approved within days of getting the paperwork requested from the endo. So they've changed their decision, as least with this particular policy.:cool:

    Cigna
    State of TN POS
    Dexcom 7+
    5 yrs. old
     
  2. sarahspins

    sarahspins Approved members

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    May 5, 2009
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    Insurance Company: Humana (PPO)
    State: TX
    Sensor: Dexcom 7+
    Age of person with diabetes: 29 (T1 for 9 years)

    Humana did ask for additional documentation and clinical notes from my endo's office, which made the approval process take a little bit longer, but they did approve it in a relatively timely manner (3 days) once they got that info :)
     
  3. hawkeyegirl

    hawkeyegirl Approved members

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    I guess I've never replied to this.

    Insurance Co.: BCBS Illinois HMO
    State: Illinois
    Sensor: Medtronic
    Age of person: 4 years old (at the time of approval)

    We were approved immediately - no appeal, no "unusual" documentation required.
     
  4. SherryFromCAli

    SherryFromCAli Approved members

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    Nov 20, 2009
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    Blue Shield of CA - HMO
    California
    Minimed CGMS
    Age 12

    We tried 9 months ago to get the cgms approved and had been denied. The rep from Medtronics said before March 2009 our insurance denied all requests. Now, almost all requests are accepted. Our insurance is paying 100%!! I just got the news yesterday and will receive the sensors tomorrow - wow!!! I am so excited!!!
     
  5. Toni

    Toni Banned

    Joined:
    Sep 14, 2009
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    2,882
    Oxford Exclusive Plan/Freedom Network (NY)
    which is now a United Healthcare Choice Plus Network
     
  6. SPICYSMOM

    SPICYSMOM Approved members

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    Jan 5, 2008
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    UHC covered Dex

    United Healthcare
    Virginia
    Dexcom 7 plus
    49 - almost 50!

    I did have to order thru Edgepark Medical. It covered 100% of their contract - >$900. But Edgepark billed over $1500. Now I only have coverage less than $2500-900 = <$1600 for all diabetes DME for the remainder of the insurance year.
     
  7. thebestnest5

    thebestnest5 Approved members

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    3,001
    I thought I'd replied to this already.


    SelectHealth HMO, out of Salt Lake City, UT
    coverage approved 6/2007
    Minilink and sensors covered 80/20 after deductible


    Then, we had to switch insurance

    A & I Benefit Plan Admin. out of Washington State
    10/2008
    Minilink (replacement transmitter for DD) and sensors covered 80/20 after deductible

    Company changed insurances...

    United Healthcare
    80/20 after deductible for in network
    had guardian approved for DD; so she could have predictive alarms and less disturbing sleep as I could set guardian on her bedside table
     
  8. Flutterby

    Flutterby Approved members

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    BCBS of MA
    Medtronic minilink/guardian
    and sensors.

    90% coverage, after deductable and sensors are covered under regular pharmacy with regular co-pay.
     
  9. gatita

    gatita New Member

    Joined:
    Feb 10, 2010
    Messages:
    1
    BCBS of New Mexico
    Dexcom 7
    58 yrs old
    Now appealing Medicare denial as primary
     
  10. mrcool

    mrcool Approved members

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    Feb 24, 2009
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    BCBS of Michigan
    Medtronic Guardian
    100% coverage
     
  11. Lisa P.

    Lisa P. Approved members

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    Aetna
    Colorado
    Dexcom
    3

    Great thing, collecting this info.
     
  12. ACrawford

    ACrawford Approved members

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    Nov 21, 2009
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    My son will be 2 in July and I am fighting tooth and nail to get him a CGM. I've been appealing since the beginning of January. Hello!! He can't even talk! VERY frustrated.
     
  13. GinaB

    GinaB Approved members

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    United Health Care
    main company in Ca but he works out of Tx
    Dexcom
    11

    very easy process. We have a DME yearly cap of 2,500. They paid for the unit and will end up covering almost the entire year of sensors before we meet the max. They have a contract with Dex and pay much less than the list price.
     
  14. SeacoastMom

    SeacoastMom Approved members

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    Apr 5, 2010
    Messages:
    73
    Cigna
    - NH
    - Dexcom Seven Plus
    - 9 years old
     
  15. frizzyrazzy

    frizzyrazzy Approved members

    Joined:
    Dec 23, 2006
    Messages:
    14,141
    - US Family Health (Tricare prime)
    - MA
    - MM
    - 9
     
  16. Mistync991

    Mistync991 Approved members

    Joined:
    Feb 10, 2008
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    1,105
    we just found out we got approval! should have system next week :)
    mm revel
    medcost insurance but out of network is penwestern...so pretty much all d stuff goes through penwestern..approved first try

    dd will be 9 next month, dx at age 6, also has celiac
     
  17. zell828

    zell828 Approved members

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    We just got our 2nd CGM. First one was in 02/2009. Now this one was today (07/26/2010). We had HealthPartners of MN both times. No problems whatsoever.

    I hear now they may be changing to Medica insurance. I know nothing about them or if they will cover these such things.
     
  18. elgaralex

    elgaralex Approved members

    Joined:
    Dec 15, 2006
    Messages:
    19
    Denied Coverage


    Hi, we were denied coverage through Blue Cross/Blue Shield/ Horizon of NJ. If anyone has any suggestions or links I can research, I would be so grateful. Thank you.:(
     
  19. rmccully2000

    rmccully2000 Approved members

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    Jul 14, 2006
    Messages:
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    We were recently denied by BCBS of Illinois (had previously been covered through UHC). The brand we use is Dexcom and I used this page for multiple CGM studies in my appeal: http://c0850852.cdn.cloudfiles.rackspacecloud.com/Continuous_Glucose_Monitoring_Reference_List.pdf

    I'm sure the other brand has similar pages so try their websites also. The denial was based on the fact that he is under 25 years old. I was able to pinpoint a study from the link (the first one) which indicated not much benefits for patients under 25 but it's flawed. I pointed out that the groups under 25 did not wear the CGM as much as the above 25 group. Then pointed to the other studies on the page showing benefits for children.

    Good luck! Just sent mine certified mail this morning.
    Becky
    Mom to Mason, 10 Omnipod/Dexcom dx 11/05
     
  20. elgaralex

    elgaralex Approved members

    Joined:
    Dec 15, 2006
    Messages:
    19
    CGMS denial insurance link

    Thank you very much. Ellen
     

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