My insurance compamy recently adopted Medicare guidelines. So when I saw that Medicare approves CGM's w conditions I thought, great now I can get my CGM (dexcom) covered!! But wait there is a hitch. They use Medicare guidelines for devices that they choose to cover, but the CGM is an excluded device. Seems kinda unfair that they can choose when to follow the Medicare guidelines and when to ignore them.
On another note now we need C peptide tests to qualify for continuining insulin pump supplies. Has anyone had any luck in getting pump and or infusion sets approved thru medicare guidelines without an acceptable C peptide?
Oh my gosh! That’s my situation and question exactly! Our insurance just switched from HAP to BCBShit (thrugh GM) and they follow medicare guidelines BUT NO CGM! I couldn’t believe my ears! If ANYTHING should be covered it should be a CGM. Mine has pretty much saved my life on several occasions with a BS under 40 that I would have slept through. And, they don’t cover the Omnipod (of course)
I have talked with at least 10 different people from BCBShit to Northwood to Omnipod. I wish I knew that Medicare covers CGM’s, I would have asked about that little contradiction. Omnipod rep is going to contact BCBShit tomorrow and “discuss” the situation. Don’t know what, if anything, she can do. I’ve also talked with Minimed (since that will be covered) BUT… will they NOT cover the sensors for the CGM part of the system!!!
I asked for the paperwork to file a grievance but I’ve been wondering if anyone has gone through this process?
Barb, I meant to respond to this post the other day and just saw your reply when I started looking for the post. I have a friend whose husband works for GM. Their daughter has an intellectual disability and uses both the Pod and Dexcom. They found out a few weeks ago that the new policy won’t cover either. When she talked to the Pod people at the end of Dec, they told her to call back after the beginning of the year. When she did that, now they are not offering much help. Her husband sent an email to a HR person at GM and she ended up getting a phone call from someone at the insurance company. They are getting information from her daughter’s doctors & then their doctors will decide whether or not to cover it. She posted her story on the ADA site and I know there was another GM person that posted in that thread that also posts on TuD – that person was also concerned about losing her Dexcom. My friend Mary said the more people that complain to GM, the better. Her Dexcom rep told her that Ford did the same thing and then ended up changing the policy because of all the complaints.
Barb, I gavce bad info, Medicare does not yet cover CGM, it is Bl=ue Cross Blue shield under its normal policy that covers it. GM bought special coverage for salaried retirees that does not cover the CGM’s I finally decided I wanted to live better and longer so I purchased out of pocket. Its only money and I can’t take it with me! I wonder if the union folks are covered?? In the whole GM bankruptcy the salaried retirees got thrown under the bus - 5000 deductible on insurance with 7000 out of pocket. Because it is not a "covered " benefit, the cost of the CGM does not go to the annual out of pocket maximum. Ain’t it great to have insurance!! I guess i shpould not complain as so many have no coverage.
My friend whose husband works at GM is a current employee and they are being told that they will no longer have CGMS coverage since the first of the year so it is not just the retired folks!
I’m kind of curious if salaried and union coverage is different. We’re salaried. And I was right, they’ll cover the Minimed pump but not the sensors for the CGM portion. I really want to fight this but I don’t know what I should send them, I’m sure they’ve heard it all before. Seems like I should I go to the HR department at GM, not the insurance people. Maybe we can find all the GM people on this sight and organize a phone call attack! I’ll be damned if I’ll pay out of pocket for a huge deductible plus the monthly insurance payment plus money going to our flex plan and still have to pay for a CGM, frustrating!
That I don’t know. I did send a link to this thread to my friend and I will also ask her. I am thinking that he is salaried based on something she posted on another about board this same subject.
Barb, my friend’s husband sent an email to the HR people and then they contacted the insurance people. I have a feeling from what my friend said, the HR people don’t even realize what a problem it is. I think you should fight - I know my friend will. Alot of insurance companies turn down people for a CGMS and alot of people won’t bother to fight back. I was denied and won my appeal. I have a feeling only a small percent of people bother to fight back.
Apparently there IS a route to get CGM coverage from Medicare even though I know we’re discussing private insurance here. check this link to the JDRF if you are Medicare covered. http://www.jdrf.org/index.cfm?page_id=111470
Hi Barb, I am the person that Kelly was telling you about. We had HAP insurance before and no problems. This Blue Cross is a nightmare! These people that work for Northwood don’t know anything, except to tell us that these things are not covered. That is NOT what the “Your GM Benefits” says about these items. Pages 71 -74 deal with durable medical items. It says that portable insulin pumps and home glucose monitors are covered for certain diabetics. Northwood just says it is not covered. There is nothing that says that Omnipods are excluded, and Northwood even told Insulet that we just needed to call and get an in network provider. Of course when I called a second time to verify this, I was told again that it simply is not covered.
My husband is dealing with HR and that is who turned it over to someone at Blue Cross. There have been 3 different people at HR made aware of this and have sent him e mails and they are the ones that got the woman from Blue Cross looking it this. She has called me a couple of times and is contacting the doctors for more info before turning this over to their doctors to review. I do have the appeals package ready to start on if they say no.
The more people screaming about this the better. I don’t know if Tony was your trainer for the Dex, but he told me that Ford had this same policy and someone fought against it and that Jan 1st they had coverage because of it. He offered to get me in touch with her, but I haven’t heard back from him.
I don’t know how to get you my e mail addy on this board without posting it here, so if you could send me yours, we could be in touch and hopefully help each other to get this coverage. I am just sick about it and willing to fight as long as it takes. We cannot afford to pay for this out of pocket and shouldn’t have to be made to switch. I wish they would give me back my HMO!
