I can really use some advice from anyone who has managed to get Medicare to cover a percentage of the sensor costs. Whether one uses the old Sofsensor or the new Enlite, it costs about $400 per month.
Since my endocrinologist prescribed it, the CGM has kept me out of the emergency room for just over two years.
I am being tossed off my beloved, company sponsored, HDHP and forced into Medicare( which is proving to be a lot more costly, with less coverage, by the way). I have secured a Prescription drug plan and Medicare supplemental. The supplemental plan covers the amount OVER what Medicare pays but the problem is Medicare won't cover any of the cost; therefore the insurance will not participate either.
The HCPC code for these is A9276.
I can't believe that I am the first to encounter this so I am asking for any guidance you can give me.I am quite prepared to take up the battle, but would really enjoy the benefit of your previous experience.
Thank you so much.
John
Good luck on your battle. As far as I know Medicare will not pay for sensors. I am still using some out of date sensors that I bought before Medicare but I expect I will have to start paying for them myself. BTW - the soflsensors are 10/$439 and last for 6-7 days, so I figure 4 permonth at about $175. I am hoping that MM gives at least a little discount for 'cash' (ie no insurance).
Let me know how the battle goes.
Thanks Carole. I plan not to give up too easily, if for no other reason than it makes economic sense for Medicare too. Over the past two years, I have not had a single emergency room, or other expensive paramedic visit. So, despite their inaccuracy, CGM's do help.
Medtronics will give you a 20% discount, for sensors, so that would knock the monthly cost down to about $351 for 10, at one every 6 days that would be about $175 for 5 a month, ($140 for 4,but that is a bit dicey for my liking).
As it was explained to me, the process works like this; 1)get a prescription for the CGM and sensors. 2) Order a supply from medtronics, and instruct them to bill both medicare and your supplemental insurance. 3) when medicare rejects it, oyu'll have to pay the discounted price. 4) Have your doc. provide a staement of medical necessity and then file an appeal, with medicare, to have their decision reconsidered. That's when I figure the real battle will begin.
If enough people file enough appeals, (as opposed to just snottin' and snivellin') then we will get it covered.
Another thing I learned; the new Enlite sensor, which officially lasts 6 days, actually does work with the 723 pump/CGM. Evidently, they have been using it outside of the USA for some 3 years or so. They are twice as expensive, but last twice as long. Problem is, you need to get your doctor to prescribe it for an "off label" use as MM will not ship it without that prescription.
Keep up the good fight, we can win this, despite the govt health care system.