I called Medtronic today and found out they don’t even submit to insurance companies requests for the CGMS if they know that the insurance company will not pay for the CGMS. I gave my lovely Molly a bit of my mind and stated how would the insurance companies even know the demand or desire of this device. I am sure the insurance companies love this and then know that most people will not persue. So I contacted my insurance company with this.
I am not sure how to go about this, but I am trying to get the MiniMed Paradigm® REAL-Time Insulin Pump and Continuous Glucose Monitoring System, which MiniMed upfront knows Coresource/Aetna is not covering at this time, so they did not and will not submit anything to them. How do I go about appealing something that was never even submitted to Coresource and denied? I want this medical device to avoid known complications of diabetes, by obtaining tighter blood glucose control.
This was their response:
To the best of my knowledge, we would not deny this device. However, medical necessity and appropriateness for the device would require review. These devices are meant for those diabetics who cannot, by standard means, keep their blood sugar under control. If documentation with her medical providers indicate that standard measures of maintaining blood sugar levels have not worked, then the new device could be deemed as medically necessary.
However, if she is wanting this device because it’s easier, that will not be approved. These are very expensive.
Let me know if you need anything else. My recommendation would be for her to submit documentation and medical records from her providers indicating why she needs this device. We can then render a predetermination prior to her purchasing this deviceI have a lovely letter just about finished to begin the battle.