Help!
I don’t know what to do. After several appeals and 6 months later, my insurance company approved a Minimed Insulin Pump AND a continuous glucose monitor (I’m not exactly Type 1, and Type 1’s are the only folks who get approval usually with my insurance).
I got the pump, but the medical supply was told that the CGM will NOT be paid for even though it was approved and deemed medically necessary. How can they do this?!
Has anyone ever had this happen before? Any advice as to what to do about it? I am just sitting here because I have no idea what to do.
Thanks in advance!
Is it possible that the insurance company has a “preferred supplier”? I guess my first step would be to call them and ask them why. Then, after you talk to the clueless person or persons there who probably cannot help I would do the following. 1st, I would get documentation of the approval (guessing you already have it), and of the insurance company’s refusal to pay the supplier. I would then send a certified letter to the insurance company with the supporting documentation and tell them they have 30 days to pay or provide an alternative supplier. Tell them that if you don’t hear from them in 30 days, you will file a complaint with your state insurance board. Then do it if they don’t respond. I had to complain via the state board about my insurance company demanding that I reimburse them for my pump that they had already approved and paid for. Amazing that after months of going back and forth, my issue was handled promptly and fairly…only after I filed my complaint. Good luck, keep fighting, and let us know how it goes.
I HAVE BEEN FIGHTING WTH MY HEALTH INSURANCE SINCE 09-2007 FOR MY SON WHO HAS TYPE 1 DIABETES HE IS ON THE MEDTRONIC PARDIGRAM 722 PUMP & THE CGM. I HAVE BEEN PAYING FOR IT OUT OF POCKET IT IS THE BEST HIS A1C WHEN HE STARTED WAS AT 8.2 AND HE IS KNOW AT 6.6 THANK GOD FOR THE CGM. AS FOR YOUR INSUIRANCE DON’T GIVE UP KEEP FIGHTING I AM ON MY LAST APPEAL WITH THE INSURANCE COMMISSIONER. WE NEED TO KEEP FIGHTING ION ORDER FOR OUR INSURANCE TO LISTEN AND ACTUALLY SEE WHAT A BENEFIT IT IS FOR A CHILD TO HAVE THE CGM. HOPE THIS HELPED KEEP FIGHTING!! INSURANCE COMPANIES ARE CLUELESS AS TO THE BENEFIT OF THE CGM
I have Horizon BCBS of NJ. They approved the MM Guardian last summer, so in August '07 I started using the CGM. They paid for the monitor and some starter sensors. They paid for another box of 10 sensors shortly thereafter, and then 3 boxes of 10 sensors later in the fall. I’m able to use each sensor for 6 days, so I didn’t need anymore until May, at which point I ordered a box of 10. They have not paid for that. They are now refusing to cover any more even though they initially covered everything. They decided that CGM technology is “investigational” so they aren’t covering it now. I’m beyond angry about all of this needless to say because I’ve been using it for 10 months and have benefited greatly from it. I’ve asked several insurance people that I’ve talked to on the phone how they can designate it as “investigational” when it’s been FDA approved for 2+ years. Of course, no one has been able to give me a suitable explanation. I’ve submitted an appeal that included a lengthy letter, part of which was matter-of-fact, and part of which was more emotional, providing examples of times it helped me and times it could have helped me if I had been using it, including the time I ended up semi-conscious from a low while having, uh, marital relations. I just wanted to make it crystal clear to them how disruptive to life lows can be. I’ve taken photographs of the monitor graphs of 12 and 24-hour spans of virtually straight lines just for posterity’s sake, but I printed them out and included them in my appeal letter as visual ‘evidence’. I only have one sensor left, and am holding off using it for now. Since I’m CGM-less at the moment, I’m taking meticulous records (even though I’ve always been miserable at record-keeping) in case I need to submit another appeal. I’ll have more documentation to submit as evidence that my BG’s are less stable sans CGMS. It’s my goal to be a relentless thorn in their sides until they start covering it again.
I have UHC and they approved and paid 90% of my MM CGMS last august. I used about 4 of the sensors but then gave up for a while since I was getting very inaccurate readings. After meetings with my CDE in april we decided to try it again. I had some sensors left but they were expired so I had to order 10 more which MM sent me. I didn’t even think twice about ordering more since they were covered just less than a year ago. I found out last week that they weren’t going to pay the 90% for the sensors because they are “disposable” and not “durable”! I gave hell to the woman I spoke to and was all ready to send an appeal but when MM called them, they are now reviewing the claim and I should find out within 30 days. Like Lee Ann’s situation, how could they cover it sometimes and not others? Its very infuriating and I can’t get over how many more stories like this I’ve been hearing! Don’t give up on the issue and give them as much of a fight as you can!
