I was finally able to call Keystone this afternoon and get a good, solid answer on a CGMS (or rather, as solid as I could get over the phone). The first gal I spoke to was a little confusing; she kept saying that she could check the system to see if the supplier was covered. She mentioned that if they were in the Philly area, it was more likely that they would be covered under my plan. Well, that didn’t make any sense to me, so I asked her to clarify. Turns out she was talking about third-party suppliers, not Dexcom or MedTronic as I had previously mentioned.
After a few minutes of trying to let the information soak in, I called again, because I wasn’t happy with the answer I got. I was connected to a guy, and upon asking him what brands of CGMs were covered under my plan, said to me, “So you want to see if you’ll be covered for a glucose monitor?” Not quite. I explained to him the difference, and he put me on hold for about 10 minutes.
He came back with good news! Turns out Keystone (the POS part with UPenn, at least) covers “invasive” CGMS, but not “non-invasive.” I had never heard of those terms before, so I asked him to explain. Turns out, the non-invasive CGMS is the “wristwatch type” of monitor (sort of what that girl in Panic Room was wearing). Therefore, the invasive ones, or the ones with the sensor under your skin, are covered as durable medical equipment! AND THE BEST PART…I’m not restricted to any one brand! I’m free to test them out and choose the one I like the most.
As for coinsurance, I’m covered at 90% after that $100 deductible (which I’ve already met with one order of OmniPods)! I’m not sure what the cash price is for sensors though, but 90% coverage is awesome to hear!
I sure hope this is all true and not some misunderstanding on anybody’s part, mine or the Keystone rep’s. I’ve decided to just stick with the POS for now. While HMOs have never given me any issues (I actually switched from an HMO to a PPO at my old job, and the PPO was a freakin’ nightmare to deal with-- I ended up spending a lot more for everything I did!), the POS is working just fine and everything seems to be in place so far.
Call me crazy, but I can’t wait for my endo appointment!