I purchased a DEXCOM SEVEN unit late June, 2007. I am 69, so have Medicare which does not cover CGMS. My secondary, Blue Cross Blue Shield (Federal), after a long fight, if reimbursing about 80%. It is a long story, so if you need details, email me at gary846@comcast.net.
You must be persistent and apeal, apeal, apeal. Provide lots of documentation.
Gary
Gary,
Just to let you know that BCBS (Federal) now has finally started covering CGMS systems as of January 2008. Anyone interested in the system under this plan need to have their doctor submit a request (I believe the supplier called it a certificate of need) to the provider and they will cover it. My pump supply provider, took care of all the paperwork . I got approved for it within 24 hours of submitting the request, no questions asked. I did not provide any additional information.
On April 1, I was advised by BS of California that they would no longer “assume” that Medicare would deny claims for reimbursement for Dexcom 7 sensors. Therefore each month I would have to file first with Medicare before submitting a claim to BS. Medicare told me that a ‘claim’ would probably take 60 days to process to payment whereas a denial may take up to 150 days. Given BS past performance of 45 to 60 days this would push my reimbursement time frame to 190 to 210 days!
After many phone calls to many people/enentities, I found a better way. Liberty Medical stocks Dexcom supplies and will file for Medicare and BC/BS benefits, and will subsequently bill me for whatever Medicare and or Blue Shield do not pay.