Aetna responded to my email inquiry as to why they only paid 40 cents for my $350.00 sensors, they stated they needed a diagnosis code. I know it is somewhere on this site, but if anyone could provide me with a quick code that will be covered by insurance for the sensors, please let me know. TY
250.83 is uncontrolled diabetes. Aetna will cover items with that dx, they will not always cover with other dxs.
That is insane! .40 for $350.00 sensors. The sad part is, all insurance companies are pretty much DX driven. Good Luck
Thank you Jane. I did some hunting around and went to Gina’s CGM website and found a link to Aetna’s insurance and they listed all the codes of what they will or will not cover and your code is the one.
What games we have to play to get this stuff covered, they know exactly what they are doing. They sent me another email today asking the question again, lordie. I bet next they will want the code hand written from my endo. I did all this already with my last insurance. Why did my company have to change policies/insurance companies on me. I have paid so much out of pocket already for all this diabetic crapola, it is almost like not having ins. at all.
Thanks for your help.
This is the response I just sent them, I am already sick of all of this.
I am confused by this email, but here is the diagnosis code you wanted me to supply to you. Are you already denying this claim without the correct diagnosis code applied? I have already gone through an appeal process with our previous insurance with Corvel (Coresource) and they paid for the transmitter and sensor and I assumed Aetna would continue to pay for the sensors.
Ahhhh crap this third email from Aetna says this: (not sure if this is a denial) I am so confused:
This is a follow-up to our previous e-mail communication regarding your
claims question on Karen for date of service 04/04/2008 for the amount
of $350.00 from Medtronic Minimed Corporation.
I called the provider today and obtained the diagnosis code and I have
sent this claim back to our claims department for reprocessing. Please
allow 5-7 business days for completion. Once reprocessing is completed
the adjusted Explanation of Benefits will be viewable on your Aetna
However, this claim was originally processed and allowed under an
incorrect procedure (CPT) code, therefore, based on the diagnosis for
this equipment, the equipment is considered not effective to treat an
illness or injury, therefore, is not a covered expense under this plan.
A service or supply furnished by a particular provider is covered if
Aetna determines that it is appropriate for the diagnosis, care or
treatment of the disease or injury. In determining if a service or
supply is appropriate, Aetna will take into account if the service is
generally recognized according to professional standards of safety and
effectiveness in the United States for diagnosis, care or treatment.
This service does not meet this requirement of your plan of benefits and
is excluded from coverage. You are not responsible for this charge
unless you agreed in writing to be responsible for the charge before the
service was given. The amount shown as the amount this provider “may
bill you” will be higher if you agreed to be responsible.
We determine coverage based on your plan benefits and clinical criteria.
For details on clinical criteria, see Clinical Policy Bulletins, which
can be found online at
- Select Members: public information
- Next select Health Coverage Information
- Then Clinical Policy Bulletin #70.
If you would like to appeal, once the claim is denied, please e-mail
stating you would like to appeal, and please include the reason you are
appealing, and I will forward this to our appeals department for review.
If you would like to appeal in writing, with additional correspondence
relating to this appeal, please send this appeal to the following
those SOBs, they will stick you anyway they can!!! Anyway, maybe minimed has the wrong dx. Call minimed and make sure the have 250.83. Most likely they have250.03, which is not good enough, or bad enough as the case may be!!! hahahahaha
I got another email today from Aetna about the sensors and this is what it said on the EOB. This means they are not paying correct??
A service or supply furnished by a particular provider is covered if Aetna determines that it is appropriate for the diagnosis, care ortreatment of the disease or injury. In determining if a service or supply is appropriate, Aetna will take into account if the service isgenerally recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment.This service does not meet this requirement of your plan of benefits and is excluded from coverage. You are not responsible for this chargeunless you agreed in writing to be responsible for the charge before the service was given. The amount shown as the amount this provider"may bill you" will be higher if you agreed to be responsible.
Karen, your insurance isn’t going to pay for the service’s!!! I can’t believe they did that to you!!! What’s the deal? You should call them again…It may take an act of congress Aetna is a strange insurance company.
Aetna is absolutely ridiculous!! We need to have some kind of huge protest to go along with the petition!!! Grrrrr this makes me so mad >:(