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Insurance covered part of mySentry

Discussion in 'Parents of Children with Type 1' started by lisanc, Feb 21, 2012.

  1. lisanc

    lisanc Approved members

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    Just wanted to post that my insurance did cover part of mySentry ... I submitted all of the paperwork suggested by Medtronic and they did cover part of it (almost half) ... We have independent health insurance with Golden Rule which was bought by United Healthcare.

    Pleasantly surprised :)
     
  2. Mish

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    Did you have to pay any upfront or did you submit all the paperwork before you had to commit to purchasing?
     
  3. lisanc

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    No, I paid upfront.
     
  4. hawkeyegirl

    hawkeyegirl Approved members

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    Out of curiosity, can you tell how they decided what percentage to cover? What I mean is whether it's covered at the same percentage as your other DME, otr if it's just sort of a random amount?

    Regardless, congratulations! I should really get on this.
     
  5. lisanc

    lisanc Approved members

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    No ... I was going to call ... I was interested also ... I could not figure out what formula they used ... the "repriced amount" was not the same % as the pump or CGM.

    We did include letter of medical necessity from Doctor.

    It really has been wonderful to have ... I hope you have same luck!!
     
  6. hawkeyegirl

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    If you don't mind me asking, how did your doctor phrase your letter of medical necessity? Based on the fact that the alarms aren't audible at night without it, or did he have some other creative argument?
     
  7. Mish

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    I was going to ask the same - if you wouldn't mind sharing what was said in the letter or anything else that the dr used. :)
     
  8. lisanc

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    The doctor's letter stated our A1C over past year and explained that she was in very good control, very physically active during the day, and often plays soccer at night which puts her at high risk for hypoglycemia. It also stated that the CGM alarms do not wake her and we cannot hear the alarms from our bedroom.

    I then wrote an additional letter stating that she does not wake up from lows at night and gave a couple of examples. One of which was after an intense soccer practice at night. One was completely unexpected and a normal day -totally out of the blue. I also indicated that both times the lows were caught by the CGM but unfortunately no one could hear the alarms. Essentially, a CGM which works wonderfully will do NOTHING for you if the alarms cannot be heard.

    I hope that helps.
     
  9. hawkeyegirl

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    VERY helpful. Thanks, Lisa!
     
  10. MyABC

    MyABC New Member

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    Great News

    That is great news. We submitted to insurance two weeks ago. I have not heard anything back from them either way. I am getting a little nervous as we are switching insurance providers at the end of the month. Our insurance usually pays for pump/CGM supplies at 100%. We don't have a deductible or co-insurance, so I think for us it is all or nothing.
    I wrote a note and the doctor did as well.
     
  11. 4MyBoys

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    Thank you so much for the very helpful info!
     
  12. Rcj176

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    I need to wait and see if they come out with one that does multiple children otherwise we will need a whole other shelf to hold all the mysentry sets!:(
     
  13. show2tj

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    Way to Go!!

    Awesome for you. We are getting My Sentry on Tues. Will submit to BCBS, but not betting on anything...
     
  14. lisanc

    lisanc Approved members

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    You will love it!
     

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