Does any one have the Medtronic 530G and, like me having trouble getting enlite sensors?
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Should have added that I am on Medicare and have a secondary insurance plan that is willing to pay for the sensors. Unfortunately, Medicare has changed their policy and no one who has Medicare as their primary can even get their sensor orders sent to Medicare, and, without a Medicare denial, the secondary insurer won't pay. It is my understanding that Medtronic is providing free sensors to their customers who get there other pump supplies directly from Medtronic. Since I'm not allowed by my insurance company to get my other pump supplies directly from Medtronic, I've been told that I'm not eligible for the free sensors. Anybody?
it's a frustrating situation Steve, we are trying to get some attention paid to it
http://www.tudiabetes.org/video/cgm-and-medicare-why-can-t-we-use-it
I just started on Medicare this year. I've been using the Dexcom CGM and my pre-Medicare insurance company covered all Dex supplies.
When I started on Medicare, my insurance company become second in line to pay claims. I called them because I feared if Medicare denied my CGM supply claims, then they would as well. While this is true for many so called "Medi-Gap" policies, it is not true for my secondary payer. Once Medicare denies my CGM supply claim, my secondary will pay 80% of their discounted cost. I feel lucky to have this provision as my quality of life depends, to a large extent, on being able to see my glucose data stream and receive appropriate alerts.
You say that your secondary insurance plan is willing to pay for your sensors. It appears from your experience that they have changed their policy and seek to shift the responsibility for this decision over to Medicare. Medicare does not pre-empt any secondary insurance policy from providing this coverage, as is evidenced by my secondary insurance. Most secondary insurers use Medicare as their primary eligibility screen for coverage. If Medicare won't pay then they won't pay either. I think this is truly a short-sighted policy!
Check out the letter below from Medtronic to their customers. I agree that it is frustrating that Medicare does not cover CGM supplies. However, the case that I am citing, however, means that for those using Medtronic 530G CGM supplies, Medicare will not even provide a denial for the supplies so that a secondary insurance can pick up the cost. The following is a letter I found on the internet from Medtronic to their customers who get their supplies directly from Medtronic. It offers those customers free sensors until Medicare resolves their "bundling" issue. Since we don't get out supplies directly from Medtronic, we are not qualified for their "free enlite sensors."
Dear Valued Medicare Customer,
Thank you for choosing Medtronic to assist in your diabetes care. As part of our commitment to support your therapy needs, we would like to inform you of a recent Medicare policy change on the coding and billing of continuous glucose monitoring (CGM), which may affect your CGM supplies. Most importantly, we will share how Medtronic products you need without any disruption.
New Medicare Policy on CGM Supplies
Since Medicare currently does not cover CGM products, you have had to either pay out-of- pocket for your CGM supplies (sensors and transmitter) or have your secondary insurance cover them. Under Medicare rules, we must first bill for your CGM supplies on a Medicare claim and receive a denial. Only after receiving this denial, we can then bill you or your secondary insurer for the supplies.
In early September, Medicare introduced a new policy that affects this process. This policy includes or "bundles" CGM supplies with your pump supplies if used with a "CGM-integrated" pump. Medicare has defined your MiniMedB. pump as "CGM-integrated."Because of this definition, Medtronic can neither bill for your CGM supplies on the Medicare claim form, nor get the Medicare denial needed to bill you or a secondary insurer. This new CGM bundling policy would mean that Medtronic can no longer supply you with CGM
sensors for your MiniMed insulin pump and CGM transmitter - even if you are willing to pay for them out-of-pocket or have secondary insurance coverage.
How Medtronic will respond
Because we do not agree with this Medicare bundling policy, Medtronic has decided to provide you with CGM supplies at no charge (until a resolution or correction with Medicare has been reached) to prevent any disruption to your CGM therapy, whether you have been paying for them out-of pocket or through a secondary insurer.
In addition, Medtronic will take appropriate steps with the Centers for Medicare & Medicaid Services (CMS) to appeal this new policy. We believe the DME MACs have incorrectly bundled all CGM supply codes with insulin pump and insulin pump supply codes. Although we understand how the bundling policy could apply to the CGM monitor built into the MiniMed insulin pump, CGM supplies (sensors and transmitter) are completely separate from pump or pump
supplies, both physically and functionally. We are hopeful the CMS will recognize that this policy does not reasonably apply to CGM supplies and customers like you - and will correct it.
I was told by Medtronic that Medicare will not cover CGM and my secondary Insurance won’t either. Don’t know what to do.