My husband is a Type 1 diabetic with hypoglycemia and hyperglycemia. He
had a Dexcom CGM and it was always covered by his privates insurance. He is now on Medicare and when his CGM stopped working and he tried to get a new one, it was not covered by Medicare. We are in the process of going through an appeal and have had an Administrative Law Judge hearing and are waiting for the decision. Has anyone gone through this???
SueB.
Yes man of us have and I am sorry to say we have never been successful. I am on medicare and I have secondary insurance with my wife's employer. Medicare requires my wife's employer to pay for it, albeit after medicare denies it. it is a hassle every time but if you have a decent stop gap, like an employer plan it can work. Otherwise, i am afraid I have never heard of it working.
i wish you the best of good luck, and please let us knwo how things are going. I figure a big fight is brewing sooner than later.
Good Luck
Thanks for answering me Rick. I know of two appeals which the judge ruled in favor of. One was in Wisconsin and unfortunately, the insurance company is appealing the judges decision. They are going forward to the next level. The other was in Massachusetts and he won and they covered his CGM and supplies. We are hoping that we will be another good outcome.
Diabetes Forecast's Jim Bock told me that they are planning an article on this at the end of the year. I am hoping that as you say, a big fight is brewing. Something definitely needs to be done.
went through my secondary insurance to get my dexcom... dr's letter of necessity,prescription faxes all approved.dexcom working great .6 months later nothing was paid,i get "claim denied"letters from my ins co that approved the use of my dexcom and the company i got the dexcom from someone owes $8k..am i the only one that cares?
oh,medicare is my primary insurance,they denied me also,i'm a type 1 30+ years
You are not the only one who cares. This is what I am fighting for. After we hopefully win our Appeal, and husband is able to get a CGM, I plan to go
further to get Medicare to change the guideline. The fight will continue.
sue,warrantee w dexcom,refurbished?...i've been fighting with medco for my mini-pen needles..not covered/covered/medicare/bluecross/medco round and round we go phone tag..two weeks for minipen needles,i'm running out
This is horrible. I am also completely dependent on my dexcom to make me aware of lows. I am terrified at the thought of being without it and am 5 years away from the same situation. People need to be aware of this. I wish you all the best and will keep writing to my representatives. Wish I could do more.
Thank you Joyce. I wrote my congressman and senators and got nowhere. I am hoping that an article in Diabetes Forecast will call attention to this matter. I won't keep fighting to change the guidelines even if we do win the case and get a new Dexcom. I have met many people who are either on Medicare or are afraid of going onto Medicare and need the CGM. As soon as we get our decision, I will post it...hope it's a good one. You can always contact me at mmb47a@comcast.net if you would like to discuss this further. E-mails would be appreciated.
I'm terrified to be without my CGM. Medicare sucks more than ever and I think we have Obama to thank for that! I'm so angry on your behalf. You're husband is so lucky to have you as his advocate. We are all lucky for having you. Bless you, bless you, bless you. I'm so angry about this I'm crying. Beaurocratic Asses! I used to say I wouldn't wish this on my worst enemy, but f them, I hope THEY get D. Mean of me, maybe, but I mean it, I really do. Walk in my shoes for a day you JERKS!....sorry for venting.
Gina…I do not blame Obama for this. Medicare had it’s problems long before Obama took office. I am thrilled that the Affordable Care Act will get rid of the donut hole. My husband reaches it really quickly so we are looking forward to it going away. If you want to blame anyone, blame the lame Congress who block everything. They are the ones responsible for all the gridlock. I hope you never have to be without your CGM. This is what I’m fighting for.
I am looking into this I have had diabetes 53 years and just started on cgm trying to find what Medicare plan would cover the supplies for pump and cgm. I live in NJ
You can do more. Sign the JDRF petition and get your friends and family to do the same.