I use the Bayer Contour Next link glucometer that was provided with my new Medtronic 530g pump in late 2013.My insurance company is Medical Mutual, who supplies through Edgepark. The prior written authorization I got in December 2013 ran out at the end of June 2014. I had enough strips through July 2014. On August 1, I called into my endo's office to request that they send in another a prior written auth. as they had done before, with success. After multiple attempts and phone calls, the PA at my endos' office said that the Edgepark reps told her that "She should try to use the one that is covered ,the Accu-check Aviva." I am floored. Edgepark says that Medical Mutual will not pay for the Bayer strips anymore.
I checked the formulary of the insurance company and my retirement system. Their website, BTW, makes it a tad tedious to determine exactly what meds/supplies are covered :you have to scroll through an alphabetical list of every meter that ever existed, and then click on it to see its description and if it is linked. But they tell you right up front if it is a covered device. They will cover other meters, but it appears that the Nova Max Plus may be the only Linked meter they cover. I have used it before and already own a glucose meter, but I frankly prefer the Bayer contour next link meter that came with the MM pump. It is easily downloadable , very compact, has a back light and works efficiently with the pump. I consider it a medical necessity , but evidently Medical Mutual, through the plan purchased by my former employers( I am retired from a school district and am covered by the state teacher's retirement system); does not consider it so.
My endo's office is going to appeal this decision. They gave me a few boxes ( total 40 count) of Contour Strips.. I wonder if I should not count on the appeal and just change to any linked meter( my second choice) and strips for whose strips that they will pay for? I am certainly not going back to a non-linked meter, if I can avoid it.. Haven't used any non linked meter in over a decade, except for a one-touch ultra mini for when I was traveling or engaging in sports and exercise. I liked its small size, which is one of the features I like about the Bayer Contour Next meter.
Suggestions? Appeal will commence..Anything I can do in the meantime, other than pay out of pocket for the strips I want? My endo's office can supply me with a few at a time, about 4 containers with just 10 strips each I am down to rationing strips and using whatever I already have to make this through...I guess I will just have to pay until I know otherwise. I really like this meter and do not want to switch!!This definitely will have me testing less! UGHH!
I am very grateful to have insurance. Lord knows it was such a help to me during the ankle break, the surgeries, and the therapies:I just did not anticipate that getting the most effective, efficient treatment tools would hit a stumbling block.
I would be aggravated, too! We have enough factors in our D-life to juggle everyday. You have a system for dealing with diabetes and your linked meter is an integral part of it. Outside bean-counters obviously feel that all our diabetes meters are equally interchangeable. That's not only ignorant but arrogant as well! I'm glad you're appealing and I hope you win.
When it comes to medications, I think the there should be a "grandfather" rule; once covered - always covered. Good luck.
I don't really have any suggestions, brunetta, but I definitely appreciate your frustration. I changed to the one touch from accu-chek because it is the meter remote for my Ping and discovered the strips were on a different tier and went from $40 for three months to $100 for three months. I paid it for a couple years until I got on Medicare and now get my strips free. Have you got a ways to go until Medicare? (Always a touchy question for us girls!)
I have 5 years and three months until Medicare. 3 years ago I retired relatively early in age from the school system, at 56 (No health reasons, just needed to go to other "callings" after 33 years in a public school district, which was well long enough!). Thus, it will be a bit until Medicare. I will work something out. Will call Bayer, Medtronic for advise, and higher-ups at my insurance company to inform and to agitate. I also will put pen to paper, as it IS mightier than the sword!! I do have a $35 a discount card, but still will be paying about $90 a month if I test as I would like....
Brunetta, I have the same problem with Liberty, my supplier. I had been using the FreeStyle meter since 2006, and they called several months ago and said I had to start using One Touch meters and strips. I do NOT like that meter! My endo gave me a script for FreeStyle strips and told me to take it to Walgreens pharmacy. They will, supposedly, start giving me the strips there and they will be covered. I have not been to Walgreens yet, but I have seen other people online who are getting their strips from Walgreens, and they are satisfied. Maybe you can get your Contour strips that way, but I think it will require a script from your endo.
I question the insurance company on who is overriding my doctors orders, and when and where they got their Medical degree. Then I ask when they saw me in person to make their medical decision. Too many insurance companies are in fact practicing medicine without a license.
the problem got fixed. The nurse who did the prior writteen authorizations had not indicated on theppaperwork that I hade tried any other glucometers. The insurance company told me. I called her and told her the name of at least three other glucometers I had used since being on the pump, and the approval whizzed through the next day.. I had already purchased container of 50 with my copay card,got some 10 strip vials from my doctor's office, and was able to fill the script with insurance for the rest. It was all due to a clerical error on the part of my doctor's office, not due to the insurance. Wow! the nurse called me and left a message of apology, saying that the auth went through and all I have to do is go to the pharmacy.
thanks all for your help!! I have been away in Ga for the past 2 weeks and it was great to have my strips for the trip.
When I got the CGM, I was sort of annoyed to have to disconnect the linked meter but once I got used to a slightly different rhythm, it didn't bug me any more. It always bugs me when insurers, whether they are private or public, do this sort of crap!!
