Ok so after months of trying…fighting with Dr Office to get them to fax paperwork, phone calls to insurance company getting updates and countless days waiting for a response I finally got one today…DENIAL DENIAL DENIAL! After the countless legalese that was spouted to me on the phone what it comes down to is this…I AM TOO FREAKING HEALTHY TO GET IT!!!. WTH is that all about? I am currently trying to become pregnant and because hormones play a big part in blood sugar levels I thought that it would be a good idea to get a CGMS system to go along with my pump to better insure a healthy pregnancy. Obviously BCBL of Illinois does not share this thought. You would think that they would be more interested in doing something that would effectively lower future medical costs by offering coverage for a piece of preventative medical equipment. Because of this I’m not really sure if I want to continue trying to conceive and since I am going to be 38 this year BCBS has pretty much effectively cut off my chance to have a child or at least to safely have a child. I don’t know if I want to take a chance that big of something going wrong if I do get pregnant so let me send a big shout out to BCBS for taking away my dream and penalizing me for not being admitted to a hospital in over 5 years, having my eyesight, not losing my kidneys or limbs, not irresponsibly getting pregnant and having an A1C of 6.1! You make being a good diabetic even harder…WAY TO GO!
Hi Drexxy, I’m so sorry you were denied coverage for a CGMS under your insurance. Have you talked to your OB/GYM doctor about that matter. Maybe your OB/GYM doctor can tell you in advance if he/she successfully prescribes CGMS for pregnant diabetic patients and whether you’d be a good candidate for receiving one should you become pregnant. I figure that you’ve been “fighting” with your endocrinology/diabetes doctor’s office to date. Don’t give up yet. Good luck, Lucy
Have it appealed or re-filed with MRU (Medical Review Unit), the medical policy changed recently and it may or may not work in your favor.
A denial is not a definite no.
http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=IL1&…
Sorry to hear about the Denial. I have just started the paperwork to try and get CGM system and have yet to hear of a good outcome from BCBS. I am Type 1 and have been on the pump for about 8 years now.
That said, You are more then capable of having a healthy child without the CGMS system. I have an 18 year old and 12 year old, way before CGMS was even available and prior to and during my pregnancy I was a 6.5 - doc said I was in better health then someone without diabetes. It required I eat every 2 to 3 hours for about 9 month and test myself about 10 to 16 times a day, take several shots a day, (not on the pump at this time either) but it’s was worth it.
Good luck!
Michelle
Drexxy:
let me echo the sentiment expressed here. First find a copy of your policy, not he little book the policy. If you do not have one, request it from your personnel office or the insurance company. Here is what you are looking for. Under the heading medical supplies look for diabetic testing devices. If it says, as most do, Diabetic testing supplies and devices are covered, immediately appeal the decision. If it says only glucometers are covered, then appeal ont eh basis of appropriate care.
At any rate, formulate the appeal with the knowledge of your employer. Go to the personnel office and let them know you have been denied. Ask their help in gaining coverage for a long term cost saving device. they will help out and may have more traction than anything you can do.
rick phillips
Yes - you can have a healthy pregnancy without CGM & even without a pump - I had my last two children when I was 38 & 40 (both unplanned - by me anyway) - I kept my A1C in the 6’s by constant testing & being careful what and when I ate. Since I was not on the pump I took multiple shots per day - I even did this through fairly severe morning sickness (which brought on the danger of low bs) - but it was all worth it - my two girls just turned 21 & 23 and I am glad they are part of my life.
Most all insurance companies use the deny first method to try and contain cost–because x% of peeps will not appeal…get your plan, and then plan your appeal accordingly.
Well you would THINK since this hospital is affiliated with the Joslin Diabetes Center Organization that they would be up on this sort of stuff. Unfortunately I think it will be just like when I first tried to get my pump…it’ll be me, the phone, the dr office, the phone and the insurance company and the phone lol.
See funny thing is when the rep from Medtronics first contacted them he was told that it was covered under durable medical equipment. But then he left the company and now they tell me they don’t deal with the insurance companies anymore…go figure.
I’ve had three healthy pregnancies, only one of which was on a pump (other two on MDI… my first pregnnacy I was taking NPH and regular, and he ended up being my smallest baby!)… and no CGMS (I did do a 3-day CGMS when I was nursing my daughter and having severe lows at night to help work out how to change my basals). While I’d absolutely agree CGMS would make a lot of things easier during a pregnancy, I don’t think not having it available is a complete deal breaker either… it certainly wouldn’t stop me if we wanted to have more children.
Appeal your denial, and hopefully they’ll change their minds. I want a CGMS and we just changed insurance from Aetna so I’m hoping I can get started with that over the summer 
APPEAL!!! most first requests for CGMS are denied. I was also denied. I appealed, I was denied again, I waited a year and tried to appeal again, this time a written appeal. They said they never got my first appeal so make sure to do a written one. On the second appeal, I explained how this will help to prevent me from getting many ailments like neurophy bad vision kidney problems, heart attacks, anything I could think of. I talked about how it limited my wife and I as a couple, I talked about how it limited my performance at work. Now this is the kicker. The last paragraph, I showed them how they would not be spending much money at all on the CGM device because of the saving on test strips alone. With the CGM device, I have to get 1 box of 100 test strips for 1.5 months. With out the CGS, I have to get 4 boxes a month. I broke down the numbers and they came out about even. I sent the letter and got approved. Also remember this, 80% of all appeals are granted.
Isn’t is awful how we have to fight for these things? I have to say that I had BCBS Illinois through my husbands job. I tried for several months to get a CGMS. It wasn’t even a matter of being denied. They just never recieved the paperwork I kept sending them… I mailed and faxed and called to double check address and fax numbers… It was a mess. Then my hubby’s company switched to BCBS of MN and I had a CGMS within a couple weeks. Illinois needs a lesson from MN about running an insurance office.
Insurance does seem to “loose paperwork” a lot. Another way to not pay what is due to the patient in my eyes.
Yeah they supposedly “lost” my paperwork a couple of times when I was going for my pump.