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T slim - Cigna

Discussion in 'Parents of Children with Type 1' started by maskdav, Nov 21, 2013.

  1. maskdav

    maskdav New Member

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    We are battling with Cigna to get the T Slim approved. There is something fishy going on becasue all of a sudden Cigna via Carecentrix is not covering the T Slim for some people. Has anyone with Cingna gotten a T Slim approved post March 2013? Thanks for your help!

    Mark
     
  2. sincity2003

    sincity2003 Approved members

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    What is the denial reason? Care Centrix is just a third-party biller for insurance companies. They don't make the decision whether or not an item is approved. We have Anthem BCBS, but they use Care Centrix as well.
     
  3. mamattorney

    mamattorney Approved members

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    I belong to a t:slim facebook group and had been reading that it would take a couple of appeals to get the t:slim approved by Cigna (vaguely recall that it has something to do with the delivery system being "experimental").

    However, there was a post on that group two hours ago where someone said they were just informed CIGNA now approves the t:slim with out all the appeals. Some one else said - is this recent, I had to file two appeals and just got my t:slim a few weeks ago. And the OP responded that, yes, Tandem was informed of the decision on 11/18/13.

    So - try again!
     
  4. twintype1s

    twintype1s Approved members

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    Really?!? We just got a denial letter two days ago, but it was dated 11/15. Our rep told us that Cigna has previously said they wouldn't be adding it to the formulary until March.

    Would you mind pointing me in the direction of the FB group?
     
  5. mamattorney

    mamattorney Approved members

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    Sure - here's the group: https://www.facebook.com/groups/375244712564233/
    It's a closed group, so you have to request to join and have the admin approve you before you can see the posts.

    I don't know any more than what was posted there, but for your sake, I hope it's true!
     
  6. twintype1s

    twintype1s Approved members

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    Thank you for the link. I also sent a quick email to the Tandem insurance person I've been working with, and she confirmed it's true, that Cigna has decided to cover it.

    However, what she said was: "We are still waiting to hear about the cases we have already gotten denied, like your case. We waiting to hear what are next steps are for those. I?ll keep you updated."

    I can't believe our denial came one weekend before the reversal! Seems like the denials should just be thrown away and the pumps shipped right out, right? :D
     
  7. mamattorney

    mamattorney Approved members

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    I'm glad it's true! But I'm bummed about your timing. Murphy's law . . .

    You could try calling Cigna too and ask them. I'm sure the only decision to be made is administrative: whether you should keep the same claim number (or whatever it is) and file the appeal paperwork or if should you just start over with a new request.
     
  8. twintype1s

    twintype1s Approved members

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    Good idea. I'm just happy to know that we should hopefully get it resolved by year-end, because my other son will need a new pump next year, and I'm hoping to avoid buying two in the same calendar year. And very grateful that I won't have to jump thru hoops with his, if he also decides he wants a t:slim.
     
  9. maskdav

    maskdav New Member

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    Good News

    Got this from my tandem rep:

    I just received the information that by Monday all Care Centrix employees will have been informed from Cigna that the t:slim pump is to be approved. Tandem is working on getting all information for all scenarios, like claims that have recently been denied, etc. I should know more by Monday and will keep you posted on all. Finally some good news, I will keep you posted on all. Thanks for your patience on this matter, and your willingness to be vocal for people being able to choose their own path.


    Mark
     

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