Medtronic and insurance for cgm


#1

How good is medtronic in working with insurance companies to get coverage for sensors? Medtronic sent my doctor a request for a letter of medical necessity. When it is filled out sent to my insurance company they will let me know.It would be nice just to get coverage for half even.


#2

As long as it’s not Medicare, you may be in luck. If you want to find out now, call your insurance company to see what they cover.


#3

I don’t know if it makes a difference, but I’m in Ontario Canada. I get a grant of 2400$ a year for my pump supplies. Pump supplies takes up the whole amount.


#4

For an extra data point, I was denied the 670g because my A1C was below 7.0. They did approve the Medtronic CGM however.

My insurance is through Humana.


#5

Every insurance company, and even different plans within the same insurance company, will have different rules for coverage. Gotta call em and ask.


#6

That is baffling.


#7

It’s like a doctor saying you don’t have high blood pressure; but you don’t show as having high BP because you are taking BP pills for it!! Just because someone is below 7 (not all THAT great) they shouldn’t be denied, as there are many benefits of pump therapy including getting the A1c down well below 7.


#8

Many US insurance companies use the HBA1c 7.0 data point to exclude T2 users from accessing pumps and cgms.

My suggestion, if denied the first time, appeal and appeal again if necessary. With equipment, the squeeky wheel gets the goods. Also, many US insurers post their “rules” for acceptance /denial online. Search for.your.insurer and “utilization management” policies


#9

I am in Windsor Ontario.


#10

@Dee_Meloche sorry I don’t know enough about Canadian health care to have an informed opinion. Possibly they too us Utilization Management policies to determine coverage?


#11

That’s always good advice. This might sound weird but I was actually a little relieved that I was denied the pump. I was on track to get the 670g, but the reviews I was reading weren’t so encouraging. I think I might try to get a tslim just because I really love my g6.


#12

@apmeyer27 I currently have a tslimx2 and love it! There are several users on another forum I read that are already using the PLGS update and speak highly of it. The HCT update due next summer is based on Type Zero algorithms, and Type Zero is now part of Dexcom.


#13

When Tandem comes to Canada and when I am due for my next pump which is in 2020 I would love to get the Tslim. I am stuck with the medtronic pump till then. I recently made the switch from the enlite sensors back to dexcom. The information that dexcom gives I find it more informative. It is also cheaper as I can get 11 days out of 1 sensor as apposed to 6 days, and then the sixth day is usually inaccurate.