MM Cgsm & Medicare

I’m needing to know…who has medicare and has gotten the CGMS approved. My daughter has medicaid right now…and they pay for her cgms sensors, transmitter…She recently has been approved for S.S. and now has medciare as her primary insurance.

How did you go about getting the cgms approved through Medicare? What hoops did you have to jump through? lol

Thanks to anyone that can help my daughter.

Medicare doesn’t pay for CGMs. However, I have 100% coverage under my secondary plan as durable medical supplies. Before I received their approval I had to have the formal Medicare turndown letter + a letter of recommendation from my endo.

What state are you in because Florida Medicaid doesn’t want to cover nothing for my 13 year old daughter and
her s.s has been denied 3 times. Wow your lucky.

Illinois medicaid, and now Iowa medicaid has paid for cgms for my daughter since 2007. Medicare will not pay for sensors/cgms, they say its not a medical necessity . Yea…right.

As far as medicaid paying for cgms, you have to have a letter of medical necessity from the endo, and he/she has to explain in depth the reason why he is prescribing the cgms. Documentation, documentation, documentation on your behalf is also needed. Be prepared to appeal Medicaids decision, and go up the food chair of appeals. Its not an easy task, but it can be done.

Have you seen this site? http://www.jdrf.org/index.cfm?page_id=111470 It’s a JDRF guide for getting medicare payment for CGM’s. Apparently there have been some rare success using this procedure. I remember someone posting on one of the forums that they had succeeded but it took them a long time.

Yes, I have seen that listed in on the JDRF site, but right now as long as medicaid is paying for the cgms, then we’re good. Thanks anyway…that could help someone else, hopefully!