Medicare appeal for cgm sensors

My background: I’m a t1 diabetic since 1997. I have 2 children, also t1. I’m 65 now and on Medicare. I use the 670G pump/cgm with GREAT success & stay under 7 a1c. My first claim for cgm sensors went to Medicare 4/9/2019. Minimed charged Medicare $1,824.90 for a 90 day supply and they paid zero. I called Medicare (that hurts) and they explained they WILL pay for a CGM but NOT the sensors. Which makes ZERO sense. I am thinking about appealing especially since I’m hypoglycemia unaware (sp). My question is:
Has anyone won an appeal? Is it worth appealing? Any thoughts/suggestions are appreciated.
Thank you

Currently the Dexcom G5 and the Libre are covered by Medicare. Medtronic sensors are not covered because up until now, Medtronic has not done the work to get their sensors approved for dosing insulin. Medtronic has announced that it will be working to get the Guardian 3 sensors approved but I don’t know anything about how long it will take.

Scroll down to the section on Medtronic to get the newest info on Medicare.

There are many people just living with their Medtronic pumps and Dexcom sensors. Unfortunately as you know you then lose the automated insulin delivery functions of your pump.

My understanding is that the early rounds of Medicare appeals have no cost but it is unlikely that you will prevail. It gets expensive and time-consuming in the later rounds because you have to hire an attorney.

If it were me I would just start using Dexcom which IMO is a much better sensor than that of Medtronic. I think that within a year (???) we’ll finally see Medtronic Sensors approved by Medicare. But it is up to Medtronic to get it done. And then you can go back to your automated delivery.

I have also been told that if you call Medtronic, there is a cash price that is reasonable but it is dependent on you not trying to get it covered by Medicare.

That’s all I know!

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Thank you so much Laddie. I used the “other” cgm for years then when the 670G came out I started on it. I may be one of the few, but I love it. It’s so nice to update my bg right before I go to sleep and know it will keep me level through the night. That’s been a huge plus for me. I do agree Dexcom is more accurate and required much less intervention but I’ve gotten used to the 670G. Hopefully they will improve on it. I’ve got one more 90 day order coming July 7th and minimed will ship, after that they will hold for my payment. Ugh. At that point I will have to go back to Dexcom. Luckily I’m retired from the navy so I do get some payment from tricare (75%) and now owe $484.98. Before I turned 65 tricare paid 90% which was doable. Thanks again, sorry to be long winded bob

Why not try and get the VA to cover the sensors?

I know that the VA offers the 670, as I was offered that pump (I actually put in the order and had it approved for the 670, but changed my mind and got the Tandem X2.)
So, while the VA is a pita to get thing started, they are darn easy for most prescriptions.
Sensors fall under prescriptions. And ship quick, is very easy, etc.
Transmitters (and pumps, or most DME) fall under prosthetics. And that side of VA takes a lot longer to get things to move through.

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“Long winded” is part of having diabetes and being on social media… Most of what I know about being successful with Medicare I learned on social media. So keep asking questions and as another poster suggested, you may have better options though TriCare.

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Good luck getting them covered. I have never heard of anyone on Medicare getting Medtronic sensors covered.

Thank you hammer. I retired in 96 and was giving a one time offer of military medicine (didn’t know where I would live), VA care (va was super awful back then) or civilian insurance of 90/10%. I choose the insurance and I’m stuck. I went to the va and they threw that choice in my face so, unless my type i is service connected I cannot use va care. Oh, the choices we make.
Thanks for the suggestion as it makes sense.

Thanks Dave, maybe I can be the first.

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I went to a VA briefing for medical care but they covered none of my meds and it seemed like such a hassle. I gave up that idea, but at least I got my VA ID card out of the deal, so I flash that at many stores to get a discount. Some chain restaurants give huge discounts to vets!!

Hmmmmm, good idea

My question is why would you want to be? They’re not very good. I tried them for a while, since my state insurance covered them but they were wildly inaccurate and well … I felt like I walking around with a growth sticking out of my body LOL Maybe they are better now? Best of luck! I am LOVING my Dexcom G6 and Omnipods.

You can check out Tandem offer to switch to t-slim for $999 (cash oop), for remainder of your 670 pump warranty.

Terry, thanks. I liked my Dexcom when I was on it but I’m having great luck with the 670g. I’m finding it to be about as accurate as my Dexcom. Thanks again

@Bob_McAdams is referring to the Guardian 3 sensors, and they are markedly superior to the older Enlites. When I was using them I found them to be indistinguishable from G5 as to accuracy, though they differ in other ways. And of course the point is that he’s using a 670G in auto mode and finding it really works for him, so Dexcom isn’t an answer.

Thank you DrBB. Regards, bob

Mm1, thanks. I’m researching tslim now.