My appeal to BCGSIL for a Dexcom was approved today!
Little known fact…The CPT code for the sensors (A9276) was approved for payment for all BCBSIL members on 3/1/09. So I put in an appeal on 3/4/09 and was flatly denied on 3/6/09!
Now I’m mad - how can they deny this when one of the three codes is now approved for payment?! I put together another appeal letter and received written confirmation that it was received on 3/9/09.
This morning I received a call that it was APPROVED - YES!!
Sorry, but I don’t know what BCGSIL and CPT mean. Can someone enlighten me?
I’m sorry - Blue Cross Blue Shield IL and CPT is the term that providers bill services, etc. under for reimbursement from insurance companies.
YEAH! CONGRATS!
Lois La Rose
Milwaukee, WI
Thanks…I should have known since Blue Cross Blue Shield is my insurance!
Congrats that is WONDERFUL!
We are so excited to upgrade in May!
Congratulations. I have a question, did you have to give a reason for the CGM? I would like to apply for one for my daughter, she has hypo unawareness, but our Doc only said let our dog sleep with her. I would however like something that will let her know when she is on the way down, rather than finding out when she is 34, and barley feeling it. She has only had diabetes since Nov. 08. Just curious. I have Blue cross PPO and 100% coverage, so I am hoping that they just say ok. Thanks!
Thank you! Do you already use the Dexcom? Did you see the new Dexcom Seven Plus? It’s way cool!
Thank you!
That doc doesn’t sound like the greatest of physicians. I am also interested in this topic, but we have different ways over here, in relation to obtaining CGMS.
Patti - just signed up to respond to you. I also have BCBSIL and as of 4/1 I’m sill being told there is no cgm coverage. My doc sent in a very strong letter of necessity and it was denied and appeal denied also. Can you give me contacts please? I run a Type 1 support group in Wilmette. Thanks - Merle
Congratulations … that is a great accomplishment! I hope you are happy with your new device =)
Hi Merle! Welcome to TuDiabetes - you’re going to like it here; I promise.
If you go to www.bcbsil.com/medpolicy and hit agree at the bottom of the page, a whole new world opens up to you! Look under View All Pending Policies and look for CONTINUOUS OR INTERMITTENT MONITORING OF GLUCOSE IN INTERSTITIAL FLUID EFFECTIVE 4/15/09. This lists the criteria they are looking for to approve CGMS on a case by case basis. I used the argument that the sensor CPT code was approved, why not the rest?
When you go to Dexcom.com you can print all the forms that are required by Dexcom. Your Dr. will have to fill out a form or two as well as a medical necessity letter. Recording your bs readings for 30 or 60 days is critical as well. They are really looking to approve this to aid in preventing hypoglycemia.
I think it’s essential to establish the approval of the CPT code A9276 to begin this task. Each time you call BCBSIL has to note your call and the reason for it. Once you have that reference and the acknowledgement of payment for this code it will be in your file. They HAVE to look for this :-). I had a case manager helping me on this who is my angel - I swear!
Thanks Stacey! The new Dexcom 7 Plus has so many new features - you can log the insulin you took, exercise, reasons for highs or lows. I LOVE it!
Thanks for sharing all these tips, Patti!
i called my insurance company (keystone health plan east, which is blue cross here in southeastern PA) today, and i was told that they cover “invasive” CGM’s. i wrote about it on my blog. i had my hubby call dexcom and the rep gave him the same CPT code for the sensors.
looks like it’s finally starting to come together for us who are looking to go on a CGMS! i’m so happy! =D
Congratulations Faye! I can ‘hear’ your excitement.
Have you decided on the Dexcom system?
no, i really haven’t played around with it, or any other CGMS for the matter. i’ve heard pros and cons for the brands that are out, but one feature that really stands out to me about the dex is that there is adhesive all around the sensor, whereas the medtronic one looks like the white plastic part is loose. i’m going to see if i can try out different models and go from there. 
If you don’t mind, could you share the steps you took, I would like to have BCBSIL pay for CGMS but minimed says that BCBSIL will not cover the item and would not submit it through the insurance company. Therefore, should I a) pay out of pocket and go to BCBSIL to be reimbursed b) submitt the prescription and statement of medical necessity directly to BCBSIL and have them deny and then go through the appeal process or c) ???
I am understanding correctly that the senors are a covered item but not the transmittor? do you have the codes for the items. any information that you can provide would be greatly appreciated.
Did you try to get approval on another cgms system first or was this your first choice? What influenced your decision to get the dexcom? I tried and was denied coverage for Medtronics cgms already (even though insurance rep told the company the it fell under durable medical equipment and was covered under my policy). Thinking about appealing but was wondering do you like the Dexcom and did you try any others out first before deciding on it?