Does Kaiser Permanente cover CGMS? Any details would be appreciated. Thanks.
I was successful in getting my CGM through Kaiser.
Be persistent, log the day, highs and lows to show unawareness issues. Sell them on it based on Kaiser’s participation in the CGM study released in Oct. 08. The study demonstrated that the people who benefit the most from CGMs are those that test often, wear the CGM as much as possible, have a CGM of 7.1 or less and “sell yourself” and the challenges that would not be there if you had the pump.
Talk to your local CDE at Kaiser to get a product rep to give you one for a few days. Keep pushing on the frontline professionals who you see to get them on your side. Test alot and give them the details
I had an A1c of 6 and alot of unawareness of my lows. I have to admit, the best thing about the pump is the reduction of stress I have experienced since going CGM.
I live in Livermore and it was a struggle. The criteria to qualify includes visits to the ER, the Dr and other Hypo emergencies. Note that the people who participated in the stud with 7+ A1c and inconsistent users of BGs and the CGM.
Good Luck, it as worth the fight.
John,
The Juvenile Diabetes Research Foundation (JDRF) has made a significant commitment to the Artificial Pancreas Project (APP). There are links on this page to recent studies conducted by the JDRF. These studies provide strong and persuasive support for any insurance application or appeal for continuous glucose monitor system (CGMS) coverage.
One of the main sub-goals of that project is to promote private insurance coverage for CGMS. At this JDRF APP web page, they list insurance companies that currently cover CGMS. Check it out. It shows that Kaiser for Northern and Southern California cover CGMS for Type 1 insulin dependent diabetics.
In spite of persistant appeals and support by my own physician, Kaiser Permanenete Northwest (Oregon/Washington) has consistently denied coverage of my CGM despite improvements in my A1C and paramedic visits to my home and work. Prior to my purchase of of a DexCom Seven Plus CGM, I sufferered periodic hypoglycemia events, had a horrific crash on a freeway, and was a victim of Hypoglycemia Unawareness on a regular basis despite numeroud checks of blood sugar using traditional methods. Since then–16 months–I have suffered zero events and saved Kaiser thousands in ambulance and E.R, costs. I finally gave up on Kaiser and their bureaucracy and work overtime to pay for the CGM and sensors, currently about $320 a month. I really hurts paying this but my life is too important and I could not work without it. I truly despise Kaiser Permanente.
How high have your appeals gone? Has your request for coverage been reviewed by a Kaiser medical doctor and declined?
Based on my limited knowledge one of the keys it to elevate your case to the point where the insurance company must use a medical doctor to rule on your case. It seems that few MDs are willing to say NO to an otherwise well made case for CGMS coverage.
Hello,
I have Kaiser in CO, and they covered my CGM. I sent a spreadsheet of my BG’s to my doctors office, and they could see that I was going low in the night. From that-I was covered. They authorized it and contacted medtronic. But not everything with Kaiser has been easy…I understand your frustrations.
Hi John: Kaiser Walnut Creek covered my CGM. I didn’t have to send in charts or fill out forms, my endo advocated for me. Unfortunately, I made the mistake of selecting the Medtronic/Minimed (Guardian) instead of the Dexcom. The Medtronic was so wildly inaccurate for me that I stopped using it. Best of luck to you in getting the CGM.
I attend walnut creek kaiser as well, they are being very hard on me and pretty much told me I should even try. I don't understand how it was so easy for you to get it but its so hard for me, they say kids get them easier, who is your doctor in walnut creek? maybe I can speak to him/her.
Ah yes, this is the Kaiser I know and love. Really, Kaiser is great for healthy people. As soon as you have a problem it's a nightmare. I finally "cured" my chronic foot problem myself, I stopped seeing the podiatrist every two weeks, my toes had a chance to heal (he was always cutting on calluses) and now they're fine. It's easy to get appointments, I like not getting bills for every little thing, but nothing ever gets accomplished without an Herculean effort on the patient's part.
To get CGM document you BG, the hypo unawareness and make sure you can demonstrate to them, Kaiser, that you monitor BG regularly and often and have a A1c 7 or below. You best chance at Kaiser is to have a CDE on your side.
Three years ago Kaiser San Diego was involve in a clinical study that identified which T1Ds have the best improvement in A1C after using the CGM. The study was done in four sites and showed that those T1Ds who tested regularly and had A1c's below 7.1 had the biggest improvement in A1c's when using CGMs.
The trick at KP is to be persistent and work with a CDE. Documenting daily logs w/BGs, Activity, Food and insulin helps also.
just out of curiousity if you already had an A1C around 7, how would a Dexcom be a significant help? As opposed to say you had an A1C of 10 or 12, used a Dexcom and then brought it down to 7 or 8. Wouldn't the 2nd scenario be a greater improvement? It sounds like Kaiser's logic is a bit backwards....By the way I am a current Dexcom user, just recently picked up Kaiser coverage and they refuse to even talk about covering Dexcom sensors period.
I was actually wondering about this one too; I don't have the best control right now, but I'm frustrated that I'm not better able to see patterns in my blood sugar, and I feel like I'm always chasing after numbers. My thought process that getting a CGMS would help me get back on track.