cgms coverage, or lack thereof

pancreas_fail!
By pancreas_fail! Latest Reply 2009-07-18 11:24:52 -0500
Started 2009-06-17 00:37:21 -0500

I thought I'd start a thread where we could all post out insurance provider and whether or not they cover your cgms.

I have BCBS of Michigan, they denied coverage of the minimed sensor and transmitter.

Way to go BCBSM, I love you too! Maybe some day I can not help you live longer too.


6 replies

lipsie
lipsie 2009-06-20 10:00:59 -0500 Report

I have had a few medications refused but my doctor actually did some good and had him staff do the paperwork and phone calls to get a approval, keep pushing them, don't just take a first no. Good luck though! *HugS* Shiela

pancreas_fail!
pancreas_fail! 2009-06-17 22:25:18 -0500 Report

Cool, good to know. They've said it's classified as "investigational" and not a "benefit". Do I need to pressure the provider or my employer to get a better plan?

kdroberts
kdroberts 2009-06-18 08:22:46 -0500 Report

You have to find out if it's an exclusion by your employer or from the insurance company. Although from what you have said it sounds like it's probably the insurance company.

If it's from the insurance company then you should be able to fight it and get it overturned. Your doctor should be able to help with that by helping you prove medical necessity. This will need to include things like proof of hypoglycemia unawareness, large swings in blood sugar, frequent hypo or hyper glycemia, problems overnight, lifestlye that makes it hard to test, testing a large number of times per day (eg a couple of times per hour) or being on an insulin pump. You don't need to have all of those but they are things that can help prove that you need a CGMS.

If it's from your employer then you are out of luck because the only way it will be covered is if you can convince them to go with a higher priced plan which would mean more money for them and all employees.

pancreas_fail!
pancreas_fail! 2009-07-18 11:24:52 -0500 Report

It appears to be an exclusion from my insurance company, though I'm not totally clear on that. Everyone has a different answer at BCBSoM. For now, I have sicked my Medtronic rep on them!

Sarguillo
Sarguillo 2009-06-17 14:04:50 -0500 Report

Yeah, push and dont take no for an answer at the start, Remember, the squeaky wheel gets greased first. If all else fails, get an attorney and they can tell you if you do have this on your poicy or not. And what you can do to fight it.

kdroberts
kdroberts 2009-06-17 09:36:37 -0500 Report

It really depends on the policy rather than the provider. You will probably find people who BCBS of Michigan will cover it because as an insurance company they do cover CGMS. Also, you sometimes just need to push them a bit to get coverage