Hi Lori. I know this. I have appealed with Medicare and my secondary insurance both.
I won’t go into detail at this time as like you I am tired. There is tons more to this story.
I believe that the secondary insurance needs to be aware of the impact on my husband. They initially said they would cover the sensors. And than ta da they learned from ME that this was not the case because of Medicare not agreeing to cover the Sensors. And then they will not. We had already signed with them. So that was it. My point is they supposedly researched this issue.
They need to hear the story of the impact on who they made promises to when they say they will do something and than bail. They did not do their job.
I am sharing all appeal info with the CEO of our non profit company that we use for our secondary insurance. She needs to know what is going on.
And our state Senator who is active in diabetic concerns is supporting us and looking into this on the Medicare end.
Now in the end will all this matter?
Maybe. Maybe not. But I am hoping what we are doing will help others in some way.
Maybe even move Medicare along. Stranger things have happened.
What you’re doing only benefits you. Medicare appeals do not set a precedent for other appeals. If you do win an appeal, it will only be for you and have no effect on others.
They definitely want to continue the Alice in Wonderland facade. Too bad Medtronic hasn’t used their evil powers of influence and money to get the G3 sensors pushed through the approval process extremely quickly, like they did with the 670.
Sally:
That seems to be true. But what appears may not always be.
They definitely want to continue the Alice in Wonderland facade. Too bad Medtronic hasn’t used their evil powers of influence and money to get the G3 sensors pushed through the approval process extremely quickly, like they did with the 670.
I am not a meek little sheep as the authority of poor decisions affect my husband and our family and I am going to use every channel I can and every appeal available and if I have to go as far as our State Board of Insurance I will do so.
If anything:
The neglect of this measure by Medtronic to get the 670 out and not make sure the Guardian3 Sensors were covered by Medicare was unjust.
I refuse to be apathetic and I am not saying any one else is. When it comes to my husband no wall is too high for me to climb over.
From my year and half experience with Guardian sensors, I don’t see how the sensors can meet FDA accuracy requirements for non-adjunctive use, e.g. for making insulin dosing decisions. Experience between lots was somewhat different, so Medtronics might have been having quality problems.
Yes people have posted on this site that they have. I will try to find them. Also you must know that the results of a new research study has been submitted to Medicare concerning the G3 sensors. It is possible that I saw Medicare Approval this on another forum that I am not on much anymore.
I will try to find the proof for you but not sure how much luck I will have.
UPDATE: Hi. I am a member of a Facebook group called Medtronic 670 Support Group. It is a reliable group and in May I sent this copy of a post to myself via email.
Here is post:
Medicare covers my medtronic G3 sensors and transmitter. This is how. Dr. Asks for:
“Expedited Approval” “Continuum of Care” “Out of Formulary RX “ and provides the Chart Notes etc. you described. I also pointed out to Medicare that the G3 is the only sensor that will communicate with the 670g pump and stop insulin delivery approaching low, costing them a lot less than ER and Hospital visits. My Approval is reviewed every six months and has covered for a year and a half so far. Call your Medtronic District Rep for immediate help for supplies, your trainer and your Endo or Diabetes Educator May also have supplies. Best
This instance may not be actual traditional Medicare but a Medicare Advantage (MA) plan. These plans are private insurance and often add some coverage not found in traditional Medicare.
People who use MA plans confuse communication on issues like this by referring to their coverage as simply, “Medicare.” It is not Medicare but it does provide a great deal of overlap with Medicare. In this case, it may have allowed the Medtronic G3 sensor based on an appeal from a MA beneficiary.
I wish you the best with your campaign to get Medicare coverage for the G3 sensor for your husband.
Wow. I had not thought of that. Not sure about that. May be a possibility. I am surprised that was not mentioned in this instance and in a few others I read about.
Good info though disappointing but does make sense.
I will say my eternal optimism in many arena’s is waning.
If you subscribe to traditional Medicare with a “lettered” supplement like F or G, then the supplement will not cover anything that Medicare does not cover. You may, however, carry a supplemental plan earned as a retirement benefit of a former employer. I had one of these as well.
It did provide coverage in instances when my traditional Medicare did not. My supplement, for example, covered my Dexcom CGM supplies during a time when traditional Medicare provided no coverage.
Medicare now covers most CGMs, so my need for the retirement benefit supplement is no longer necessary. I switched to a traditional Medicare supplement lettered plan this year. For me it is cheaper and provides better coverage. I use Plan G.
Sally:
