I am a California type 1 diabetic, just having lost my cgm coverage because Calpers dropped the Blue Shield HMO Medicare coverage and substituted the United Healthcare Medicare Advantage plan. Before getting the cgm in 2010 I had 5 emergency calls in 6 months, convulsions, unconsciousness and one time, a heart attack. Before our enrollment, UHC stated that they could cover the cgm as a medical exception and sent the form to my endocrinologist. Now that we are enrolled, they continuously deny coverage, stating today that they can’t cover anything Medicare doesn’t cover, even if medically necessary. We are appealing their denial with little expectation of success and will be happy to share our story.
I don’t know if you are still interested in getting more people involved or if it is too late. I’ve had my Dexcom for three years. I started Medicare with a Medicare advantage plan through United Health Care July 1, 2013. My doctor put me on the Dexcom because of hypoglycemia unawareness. January 1st this year, UHC decided they didn’t want to cover the Dexcom anymore because Medicare doesn’t cover it. The CGM has been a life saver for me. My doctor has appealed to UHC for continued coverage but I am not optimistic.
Please include me. I am just getting started on Dexcom CGM and a huge medical outlay with a initial cost of $1500 and monthly cost of $300 thereafter.
Hi Dan: Thank you! I could sure use the information you mention, but don’t know how to contact you. We are just beginning the appeal process. . MJ
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My name is Jim Waters and I am representing a Medicare enrolled type 1 diabetic at an ALJ level 3 hearing.It is scheduled the first Monday in May, 2016 and the Judge is in California. Is there any advice you could provide us as we prepare for the hearing. I am a volunteer Medicare SHIP counselor. My email is firstname.lastname@example.org. Congratulations on your level 3 appeal win.
It denies coverage to people on Medicare who have used the system for years on private employer insurance and now it is denied by Medicare.
It seems Medicare gives litle recourse to fighting their “no” for CGM’s. I’d love to have one but can’t afford out of pocket. As a result I play “catch up” by blood glucose testing. Medicare/medigap covers my pump expenses and insulin… so why not the CGM?
WOW! Good news!