Yes… Thank you.
If I read correctly, Medicare has to decline before I can file an appeal, it that right?
Kenneth Bradshaw
Yes exactly. It takes time. I wish you lived in a Maine so I could show you my paperwork that we submitted. The paperwork is easy. Print the page off the Internet at Medicare. Be very succinct but clear with what you want. The endo letter is crucial. Of course.
Ken can you reply to my message. I want to copy and paste it to someone else. I can’t figure out how to send the message sent you. Ty
Hello Sally, congratulations on winning your appeal for 670G sensors with Medicare! I am facing the same angst next year (2020) as I will entirely be on Medicare coverage (primary and secondary) with a Medicare Advantage plan through Aetna. So I would like to know the process you went through on your appeals to get coverage for 670G sensors if you don’t mind sharing with me.
I have heard the rumors about Medtronic getting Medicare approval for 670G sensors but don’t have a clue when that will get finalized. Worst case scenario (when I get close to running out of 670G sensors) is that I will switch to Dexcom but I am hoping to avoid that.
Steve
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I meant this to be a private message to Steve but here it is. Hopefully it will help others.
This is my experience, my thoughts and my opinions.
I am posting this to be helpful.
Hi Steve I am hoping Ken will reply to my original message to him so I can cut and paste what I wrote to him and get to you and another guy about Medicare and appeals. I can’t get to the message I sent him for some reason.
Here is what I know.
Stock up on your sensors right now with your insurance plan.
I hear they are now asking people if they are going to be on Medicare when you call once you are on Medicare, at Medtronic, and then they tell you that you have to pay 354. Out of pocket per box which is not really fair because there are some secondary insurance companies that will pay if you are on Medicare so they should submit to Medicare and if they deny go to your secondary but remember these people are out of call centers and do what they are told and will not most of the time get you a supervisor to speak to. The last one I talked to on the phone was especially resistant to listening to me about the whole case by case deal. See next paragraph. If you pay the 345 out of pocket I don’t see how you can get a Medicare denial because Medtronic has never submitted to Medicare. See what I mean?
This is why I called. Yes I did win my appeal for the sensors but the appeals are case by case. You would think that since the boxes were approved and my husband will be getting the same sensors that Medicare approved this time around. Nope. The call center person I called at Medtronic would have laughed full on in my face if she could have. Fortunately a sweetheart of a guy in the forum sent me 11 and I got a box for 79 off eBay. Some may be duds but I am sure some will work. Plus my husband extends each sensor for two weeks. So we are all set for now.
Steve, here is the good news.
If we are lucky and this goes thru then Medicare may be covering the G3 Sensors and you will be fine. And I hope this happens.
Also they are suppose to be coming out with a 780 insulin pump at some pt. And if you are still under warranty with yours which I bet you are you can pay a fee and update your 670 pump.
https://myglu.org/articles/medtronic-launches-in-home-trial-of-780g-clinical-trial-of-new-cgm-sensor
Do you extend your sensors?
Medicare and secondary insurance as I call it costs us about 1400 dollars a month and as you know with diabetes there could be other multiple medical issues and I have Rheumatoid Arthritis. Our plan is good and we have not paid a dime out of pocket this year at all and believe me we have loads of doctors appointments. Well enough about me.
Anyway I will be damned if I will pay 345. Out of pocket for sensors and so we appealed and won.I will send you that info also soon. We got close to 1000.00 covered by Medicare with our appeal.
People on the forum told me to not even try to appeal but I didn’t listen. It’s been a fun 38 years for my husband. Ha ha!!! Because the process is there I am willing to go thru it and I hope upon hope it will help someone else. Foolish in this day and age but I try nonetheless because it is my right.
I hope this info helps you.
I am a librarian by trade so try to give reliable info.
If you have any other questions let me know.
Though I have proofed this please excuse any incorrect spelling and grammar.
I must say it disgusts me that Medtronic pushed through the 670G without getting the G3 Sensor approved by Medicare. It’s about the money…sad.
Sally
See response above.
Hi Sally,
Thank you for detailed info/insight and great advice! Have already been stocking up on 670G sensors to cover me into next year when hopefully Medtronic will have Medicare approval to cover sensors.
Depending on the sensor heath at the end of 7 days I sometimes extend them until it become inaccurate.
Steve
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I believe the inaccuracy to be true when you extend. I really think you are all set and things will work out for you. Take care and the very best of wishes. Will get you the appeal info in the next few days. We are heading into Boston on the train presently for the day as my husband has had recent eye surgery.
Thanks Sally, hope all goes well with your husband’s eye issues followup!
Steve
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