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TRICARE - NO longer covering SENSORS!

Discussion in 'Parents of Children with Type 1' started by Lindy, Oct 26, 2007.

  1. KeltonsMom

    KeltonsMom Approved members

    Joined:
    Sep 12, 2007
    Messages:
    3,605
    Get this, Tricare might cover the sensor and the CGMS for me but not for my son..What is up with this?

    At this point I am not sure who needs it more me or my son..
     
  2. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    Let me know what they tell you!
     
  3. Jana

    Jana Approved members

    Joined:
    Jan 30, 2006
    Messages:
    121
    Wow...

    This is a mess. We haven't had any problems with Tricare Prime North yet, but who knows. We could get a call any day I guess.

    I do know that our Guardian and sensors were covered under medical from the start, and we have never had a co-pay. Our Chief of Peds Endo was the one that put the order and letter of neccessity in. Maybe something about his wording made sure we got ours under medical? I'm going to call in a bit and see what our docs have to say about it.

    Once we were approved for coverage under medical, I called Tricare and had the supply company switched to Liberty Medical. They were suggested by Medtronic employees because they work with Tricare, Medicare and Medicaid regularly. They do frequently have sensors on backorder, so sometimes I have to call two or three times before I can put an order in. It's a bit of a pain, but it's worth it. I always just start trying to order a week or two before I need to.

    I really hope everybody is able to sort this out. It's just awful that they're bouncing back and forth. Remember though, since you're all military or DOD, you can write letters to your senator to comment on or compain about things related to military life. It's the best way to get things taken care of. Please, if the issue is not quickly resolved, write you senator!! Explain CGMS and why it works, let them know what's happining with your insurance, and ask them to intervene.
     
  4. Armyemily

    Armyemily Approved members

    Joined:
    Oct 15, 2007
    Messages:
    229
    Tricare is run by different companies depending on what state (or part of state) you live in. I am in the South Region and we have Humana Tricare Prime (I will be soooo glade when there contract is up!!!!)

    Anyways I meet another girl on Ft. Sill,OK that just started on a Insulin Pump and got Tricare (humana) to cover the sensors. I have been trying to get these "people" to cover them for over a year!(they will cover the dexcom and MM for a trial but no longer then 7 days every 2 years) She gave me her doctors name and he wrote some type of letter I forgot the name of it (I will ask the girl I meet later) and now Tricare Humana will cover it!!!!!

    Also you should call Tricare and ask for a case worker that way you have one person working on your case. And my parents just got me on as a EFMP (Exceptional Family Member Program) and now I am covered for LIFE!

    www.tricare.mil then click on Tricare Beneficiaries scroll down to where it says Profile-Step 1 Then choose or beneficiaries category then your country. Also there you can create a profile and see every piece of information they have for you and your family (even RX's they have covered and dr's you have seen!) It is really cool
     
  5. semperwife

    semperwife Approved members

    Joined:
    Apr 20, 2007
    Messages:
    82
    In August when we got ours approved we were told that as of July 1, 2007 any patient already on an insulin pump would be approved at level one in utilization review without any need for further review.

    From August to Nov... no problems except backordered... then foundation care said I had to go through MM and 2 months of dealing with this and I am almost out of sensors and have no money to personally purchase them. I can't figure them out.

    Like I said I had not had any issues getting the sensors until Dec. That is when I was told by Medtronic that they couldn’t process my refill request because I needed a new authorization….the authorizations expire every 3 months even if the prescription is valid for a year. This is because it is now a medical benefit that they don't have a contract with Triwest for.

    In August this is what was approved:

    Approved
    S1030 - S1030
    Gluc monitor purchase
    MINIMED DISTRIBUTION CORP
    18000 DEVONSHIRE ST
    NORTHRIDGE, CA 91325
    (800) 933 - 3322
    8/8/2007 - 11/6/2007
    1 UNITS




    If you look at the HCPCS S Codes the code S1030 is 2007 HCPCS S1030
    Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code)



    This is what was requested:

    Not Approved
    A9276 - A9276
    Disposable sensor, CGM sys
    MINIMED DISTRIBUTION CORP
    18000 DEVONSHIRE ST
    NORTHRIDGE, CA 91325
    (800) 933 - 3322
    1/18/2008 - 4/17/2008

    Not Approved
    A9277 - A9277
    External transmitter, CGM
    MINIMED DISTRIBUTION CORP
    18000 DEVONSHIRE ST
    NORTHRIDGE, CA 91325
    (800) 933 - 3322
    1/18/2008 - 4/17/2008
    1 UNITS


    So I am confused, they spent $1,300 6 months ago and continued to pay for the sensors for the last 5 months now suddenly they don’t want to cover it? It would have been easier if they had said no all the way… we love the guardian. It has been our lifeline. Brandon has no awareness at all of lows, has shown “LO” on the meter quiet a bit, now he is feeling it better after 6 months of this machine telling him watch out. It has been a godsend in my opinion. I just don’t know what I would do without this data now.
     

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