I was told by Edgepark on my last Dexcom sensor reorder that Horizon is now rejecting coverage until there is “documented evidence of medical intervention for hypoglycemia”, and it cannot involve “only oral glucose”. So that meant to me an emergency room visit, perhaps after a car accident, which probably would end up costing insurance 50 years worth of Dexcom sensors. I am so fed up with my insurance.
However, after more research, I found that “medical intervention” also includes anyone, not just a medical professional, say a friend or family member, needing to inject you with glucagon (apparently injecting yourself does not suffice).
Insurance companies are just backwards. Once you are on a device that is intended to prevent those situations, they want you to prove incompetence by still needing to go to a hospital. It should be that they see that you haven’t been to the hospital because the Dexcom is doing it’s job to alert you before that happens, and happily renew it.
After my first year, I had to appeal several times before they gave me another year. I’m not betting on the letting me continue again, so I’ll be going through this process again in a few months…
Exactly, I argued the same line of reasoning. It’s just a frigging game with insurance, they wear you down until you give up out of frustration and annoyance. It’s borderline, if not blatantly, criminal I think.
When I lived in Switzerland it was almost pleasurable to deal with medical matters. No friction. In the US it is pure hell.
Hi Mark,
The insurance companies are so interested in saving pennies now, that they ignore the dollars spent later. When I first wanted to go on the CGM, my insurance company (Blue Shield) refused me. It took over a year of appeals and finally, a “medical review panel” to decide in my favor! The review panel consists of three doctors who are not associated with B.S. (interesting initials) or with me, who decide whether or not a certain benefit should be allowed. The insurance company HAS TO abide by their decision.
You may want to look into this.
Take care
Have you started a ‘request for re-consideration’ or ‘level 1 appeal’, or whatever they need to get your coverage request AWAY from unqualified Gatekeepers and into the hands of an MD who can be held responsible for the Denial?
The exact wording of your letter is key – if you do it well, then you’ll need to write only one. And BTW, I love assisting people with these letters! When T1 PWDs have the anger and GUTS to send a letter which I’ve drafted for them, their insurance has always agreed to cover.
But the letters are pretty harsh. They include phrases like “practicing Medicine outside the scope of his/her competence” and “licensing board inquiry”. If you’ve got the GUTS to send something like that, then you’ll almost certainly win- on the very first letter. Send me a PM if you want to proceed.
Whenever we let InsCo’s get away with such policies, we encourage them to apply even MORE restrictions in the following year. Your case is not relevant to you alone, it affects everyone on CGMS.
i love it. load the 16 inch guns and blast point blank range.
Neat - rickst. glad to see you are still kicking. points all correct and the medical cost crisis will be absolutely staggering if we honestly take proper tack/approach to solve t2 crisis not just one fingerstick strip a day allowed.
