Just been turned down in my attempt to get a Navigator.
I have Medicare Plus Blue. (Blue Cross)
Started the appeal process, whatever that is.
Any of my friends out there gone through an appeal process?
Anyone appealed who has same insurance as me?
I’m frustrated and a bit depressed because my night time lows have, fairly recently, become a very major problem.
Type 1 for 56 years and a recent A1H of 9.8.
I feel as though I might be better off maintaining a higher glucose level in order to avoid these night time lows. The other day my neighbor called EMS. By now I’m on a first name basis with these medics.
A CGM would truly save my life but isn’t covered. An insulin pump, which I don’t have or need, would never save my life and is covered.
Any and all responces will be appreciated at this desperate time. I don’t want to discuss pumps.
Jim
Jim check and see but I do not think Abbott Navigator is contracted with BC or BS. I want one cause of the small sensor so I am going to have to save and pay out of pocket. Call your insurance and ask who they are contracted with. It may or may not make a difference.
Be loved
I was denied by my Blue Cross Blue Shield plan at first, but was able to gain coverage for my Navigator by proving that I experienced multiple blood sugars below 50 mg/dL each month. I showed them two months of blood sugar logs (testing 8-14 times per day) where I experienced 5 or 6 blood sugars in the 40s each of those 2 months. It took me from July until November to get coverage and begin using the system, but I’ve now been approved for one year.
Here is a link for my insurance plan’s specifics regarding eligibility for CGMS coverage. I’ll copy and paste a small portion here:
"Long-term use of continuous interstitial glucose monitoring devices as an adjunct to standard care is considered medically necessary for the following:
Patients with Type 1 diabetes who meet the following criteria:
Recurring episodes of severe hypoglycemia (<50 mg/dl); and
Inadequate glycemic control despite:
Compliance with frequent self-monitoring (at least four times per day); and
Multiple alterations in self-monitoring and insulin administration regimens to optimize care; and
Insulin injections are required 3 or more times per day or a medically necessary insulin pump is used for maintenance of blood sugar control; and
Four or more fingersticks are required per day."
My advice is to check the many conversations on this site where people have discussed how they got their coverage. Many of your friends here have gone through three and four appeals before finally gaining coverage. Take heart, stay informed, and be your own advocate. Do not take no for an answer. Log your blood sugars like a maniac (because they will definitely ask for your records) and see if you can get your doctor’s office to uncover the phone number or extension for the person specifically responsible for denying or approving the claim. That helped me SO much. I was able to plead my case in a less-than-ten-minute conversation on the telephone. It’s a little harder for them to tell you no than to write you a denial.
The idea of maintaining a higher BG to avoid lows is a dangerous one and I hope you choose not to do that. But I know that your lows are getting scary. 
Have you talked to your doctor about adjusting your dinner meal time or composition, your insulin dosage, or doing 3am blood sugar tests reguarly?
That being said, I do have a slightly higher target for nighttime hours. My target BG is 100 throughout the day and I correct all sugars within about 20 points above and below that, but before I go to bed, I shoot for 120 and won’t correct anything under 140.
Thanks Laura, To me, buying the CGM is a very doable thing. The sensors, changed every 3-5 days at $50 apiece, is another matter. The math on that is another $3600 per year (approx.). Yipes, along with the rest of my meds., well…, it just amounts to way to much for me.
I’m not quite sure what you mean when you tell me to inquire as to who my insurance is contracted with.
I have Medicare as my secondary and BC/BS as my primary. Medicare Plus Blue, as stated above. I’m sure I’m missing your point.
Please let me know.
Jim
Well when I called about the Navigator they told me they were not contracted with Anthem BCBS since then In a conversation with our wonderful MelissaBL I might have been told the wrong thing. I have coverage through Anthem BCBS for my sensors I use medtronics but want the Navigator cause the sensors are so much smaller. I had to supply a 30 day log that showed my highs and lows and my constant testing. I guess what I need to do now is call Anthem BCBS and see what they tell me if they are contracted or not. What MelissaBL has said is what you may want to submit and ask the people at Navigator to help you.
Does that make more sense?
Be loved
Excellent letter Melissa, as good as I have seen here.
In addition to my meter and its readings, I have been keeping log books since way before meters were introduced. Twenty years, or more, of such books. I would sure hope to get them back after they check them.
I fit all aspects of the criteria you mentioned. Many times, however, while my glucose is low, I will eat, etc. before testing so the number won’t look so bad and bring down my average. In other words, I cheat so my average will be around 100 for the week. Possibly hurt myself with the situation we are talking about here. Still have, however, plenty of -50 and +200 recorded.
Do you know I have been diabetic for 56 years? Because of this length of time involved, the telling symtoms of low, and high, glucose become less and less noticeable.
If it wasn’t for my great wife of 42 years and her ability to correct hypo. events in any way necessary, I would be dead. This is a blunt fact. These early morning emergencies are upsetting to her as she seldom gets back to sleep, and other things.
I can hardly imagine how anyone could possibly need a CGM more than I.
My last A1H was 5.9
I’m quite new to this site and tend to lose people. I hope you won’t mind if I give you my email address.
I say this because I would like to keep in contact with you. You have answers. I have confusion.
jmd44@att.net
The person personally responsible for my claim sounds great, but I wouldn’t know where to begin. In addition, my doctor is not easy to contact without an appt. What a schmuck!
I fully realize I am asking for your time and you have lots of things you would rather do. Pardon me for this.
Jim
Yes it does. You must have been dealing with Abbott Labs for the Navigator. They were helpful to me by sending all the forms for both my doc. and me. They also gave me encouragement.
Then, when they got all the paperwork they required, they turned it over to Byram. This arm (I guess) of Abbott then tries to obtain an approval for the CGM.
It was Byram who called me with the denial news and they were not either pleasant or knowledgable.
When I called Byram back the next day some person tells me Byrom is turning it all over to Mini Pharmacy for them to try for approval.
I feel like I have been blown off.
Please keep the cards and letters coming.
I feel as though I’m hanging onto something with my fingernails and not even sure what it is.
Jim