Insurance Approval for CGMS


#1

Hi there,

Does anyone have any tips for getting a preauth from their insurance? I have commonwealth indemnity and I’m having a devil of a time slicing through their bureaucracy. Apparently my Doc needs to write a lettter- any specific language you all would recommend?
Thanks in advance,
V.


#2

Your doctor probably signed a “Statement of Medical Necessity” just for you to buy the CGM. There should be a copy in your file and a copy on file with Medtronics or Dexcom (whichever you have.) It’s really a prescription. Get a copy of it from one of them to submit to the carrier. It basically says that use of the CGM is clinically indicated based on various factors. Mine says “wide fluctuations in blood glucose values” and "AM hyperglycemia (dawn phenomenon). No company will sell you a CGM unless you have one of these statements.

I just got Blue Cross of California to pay 50% of my receiver and 50% for a box of sensors for my upgrade to the Dexcom 7.

After I first submitted, including my doctor’s signed ‘Statement of Medical Necessity’ and an invoice from Dexcom marked “Paid”, Blue Cross asked for additional information - information which wasn’t asked for on the claim form, by the way. What they wanted was the ‘Procedure Code’ for the items. Based on advice read at the yahoo group ‘diabetescgms’ I resubmitted using procedure code E1399 for the receiver and A9900 for the Sensors. (The Diagnostic Code, BTW is 250.01.)

Two weeks later the check arrived.

I’m a happy camper.

Terry