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No CGMS uinless on the pump

Discussion in 'Insurance Issues' started by Carmen, Feb 18, 2008.

  1. Carmen

    Carmen Approved members

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    Jan 20, 2008
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    I have been told by the insurance company that they will not cover the CGMS unless my son uses it with a pump. Any ideas on the arguments I can use to appeal this decision. I cannot figure it out why the link the use of the CGM to the pump. My son is on MDI and has a good A1C.

    Thank you.
     
  2. rickst29

    rickst29 Approved members

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    Sorry, but your case looks hopeless for a different reason.

    If Stéphane was age 7 or above, then you could proceed as follows:

    (1) Ask them to first explain EXACTLY why pumping is "prerequisite" for MEASURING Glucose levels. (In writing.)

    (2) Also ask them to explain why the FDA-Approved Labeling for both Minimed Guardian and Dexcom doesn't require the user to be using a glucose pump, but they get to create such a "requirement" at their own pleasure.

    (3) Then ask them for the medical licenses (license number(s) type of license(s) AND State in which the license(s) were issued) of the persons who claim to be more expert than the FDA review committee, because the appropriate Medical Boards might want to order remedial education or disciplinary action.
    - - - - -

    But *YOU* can't do that, because she's under-age. They'll just turn around and deny it as "experimental" in a child so young, and you absolutely can't win that argument. :mad: Great question, sorry I wasn't able to help.
     
    Last edited: Feb 19, 2008
  3. Carmen

    Carmen Approved members

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    Interesting ...

    Thank for your reply. It is interesting that they never asked about my son's age. I specifically asked the Medtronic representative if the Guardian was approved for children under 7 and she said yes. I wonder if this is just the way things are in Canada; maybe Health Canada approved the CGM for all ages...
     
  4. rickst29

    rickst29 Approved members

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    yes, I was assuming USA.

    I don't know anything about CDN health system appeals, or whether they would allow if you'd already jumped over the pump "barriers". :cool:
     
  5. funnygrl

    funnygrl Approved members

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    I would say let them buy you a pump if that's what they want to do. No one says you have to use it once they buy it though.
     

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