I am now at my wits end and need some help. I had appealed the coverage of my CGMS and received my letter of denial this Saturday. I had do appeal this through a Trust Fund that supplies my medical insurance which currently is Blue Shield. The letter told me that the trust fund "adopted Medicare guidelines for coverage of durable medical equipment". Then it goes to tell that "Medicare considers a Continuous Glucose Monitoring System to be precautionary and does not cover the item".
My question is this has anyone on Medicare ever gotten coverage for a CGMS? What did you have to go through to get it?
They didn't even address any issue that I mentioned in my appeal especially the hypoglycemic unawareness! I am really really ticked right now and just don't know what else to do!
I'm not on Medicare but I have Blue Cross-Blue Shield coverage. I have heard that it is difficult to get a cgm through Medicare but I would think that your hypo unawareness would help your case.
I am also hypo unaware and use a Dexcom cgm. Have you tried going through the cgm company and letting them handle the negotiation with the insurance company? That's what I did.
Dexcom had me fill out some forms with the option to write an explanation of your need for a cgm such as the hypo-unawareness. Then Dexcom got the records from my endo and handled everything with my insurance. Before I knew it, I was getting a call that my cgm was being shipped.
Hopefully some of the folks on Medicare here will drop in and comment. Good luck to you!
Thanks smile, I did try and go through Medtronic but I guess I will have to be much more persistent! I have even tried my State Representative to see if they know of any way since Medicare is through the Federal guidelines. I'm really curious if anyone on Medicare has EVER gotten coverage.....
Your endo should know the ins & outs. I'd been by ambulance several times with low sugar. 1) I live by myself and need indicator when it's going low 2)my work, I was a custodial mngr on a campus research facility - I was the only mngr on at night and in charge. Had dangerous chemicals, etc. needed to know before too late if sugar getting low. If you'd like you can email me, tsheff1@hotmail.com and I may be able to ask questions or point key things out to help. I had Blue Cross Blue Shield then changed over to CDPHP and both approved & paid for them.
-Tammy
I use Kaiser Permanente. I Live in California and I know it is not in most states. I know many people that use Kaiser Permanente to assign their Medicare benefits.
Kaiser pays 70% of all glucose testing CGM and regular fingersticks on my plan, The people who have medicare can choose plans and I believe it ranges from 50-70% coverage. I know that Kaiser permanete is very good about preventive care, I 'm sure that there is an insurance company that will do it the same way for you, It may be an HMO or Managed care institution, but I bet if you called around you could find one, There are a lot of Medicare groups that offer a lot more than the standard big companies do.
Eileen, My name is Dave I want you to give me a call so that I can talk you through this. I had gone through three denials and had a hearing with the ALJ (judge) and got a favorable decision.However when I reordered my supplies, medicare again denied me. So now I have started my second set of appeals and again intend to go as far as I have to and I am determined to go and do what ever I have to to win this thing once and for all. So give me a call at home on Sunday afternoon around 7:00PM eastern time because I live in Pa. 1-570-628-5269
