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Premera BC

Discussion in 'Insurance Issues' started by lilituc, Apr 16, 2009.

  1. lilituc

    lilituc Approved members

    Sep 1, 2006
    Does anyone here have Premera Blue Cross through a certain software company ;) and had their CGMS covered? Were there any restrictions placed on qualifying for it?

    I thought it was covered with no problems, but a friend is trying to get the MM CGMS covered through them and is getting conflicting information. I'd really appreciate more information. Feel free to PM me also.
  2. Diana

    Diana Approved members

    Aug 23, 2006
    We have Premera BC (not from that particular software company :rolleyes:).

    We were able to get CGM approved on appeal - I believe we were the first approval. Premera has a position paper on CGM available online that outlines their position on CGM coverage (only in very limited cases). I had to google to find it - I couldn't get it on their website. The example they gave for coverage that I remember was severe hypo unawareness AND a high risk job (like a truck driver). My son is in 2nd grade so he didn't quite fit that criteria. We made a good case though.

    I don't know how dependent coverage is on the particular contract the software company has with Premera. Last I checked on ours, CGM was not considered a covered service (our claims get kicked back all the time because the codes are "not covered services". They do get paid eventually though, because we won coverage on a special case basis)

    Good luck to your friend.

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