I have Anthem Blue Cross, and I was told through Medtronics that they approved the CGM…sent it to me along with supplies and have been sending sensors when I have had to get extra because I am only able to use for 3 days before they really malfunction…Our insurance in a PPO through my husbands insurance…found out on Thursday (which happen to be my birthday) that even through blue cross pays for the CGM doesn’t mean that they (Sierra Pacific Inductries)…so right now it’s up in the air…Just praying that I don’t get billed from Medtronics for this huge amount…that would upset me deeply…
Dawn – you’re situation is WAY more difficult than most: Anthem is really just the plan administrator, and Sierra Pacific is “self insured”. The big danger in FIGHTING for coverage from a “self-insured” company is that, although it’s officially illegal, word “magically” gets around that your husband is, “somehow” an exceptionally expensive employee, and his Supervisor’s departmental budget “might” have more or less favorable treatment next year…
It’s illegal, but in Nevada, it seems to happen all the time. (I’m assuming that you are meaning the “Sierra Pacific” a.k.a. “NV Energy”) Think hard about how secure your husband’s job is, before you start fighting against HIS OWN personnel department.
Their “policy paper” is not the defining document, the POLICY is. What criteria did your Endo list?
Send a friend request if you’d like to try going after it again-- AND if you’re still within the process time limits (typically 60- or 90 days after the last denial, the one you did NOT yet respond to.)
Blue Cross Blue Shield NC - Denise helped and provided me with the appeal forms and they approved it Monday after a 2 year fight. 70% up to 3,000 - then I am covered 100 %
Healthnet Northeast, though I still don’t know whether it is covered as diabetes supply (co-pay, unlimited) or durable medical equipment (% covered up to $1,500/year).
Took me five months of phone calls, letters, appeals, and threats. It’s still so expensive I don’t know that I’ll be able to continue.
Cigna (PA) covered 100% of the cost of my Dexcom CGM and 2 month supplies. I think also cover the supplies at 100% but I have another month before it’s time to reorder.
Medical Assistance is actually covering mine, first time they covered it in my area. I was lucky because they wouldn’t before, my therapist and endor. teamed up and made it happen
Tricare. I’m active duty in the U.S. Navy (for now at least), and the covered the entire Paradigm 722 system. I had seen and heard a lot of mixed comments about Tricare covering it, but they came through…
Hi ,
We have cigna as well and wanted to get the medtronic pump with the cgm. {our warranty is up } what kind do you have and how much of a process was it?
felice
United Health Care Choice Plus through my employer AT&T. Not the best, not the worst. I didn’t require any appeals. They covered it right away as well as my MedTronic pump. They do not however cover the OmniPod. And now I am locked in with the MedTronic pump for 4 years.
TriWest (TriCare) the military insurance…we had to jump through alot of hoops and give them lots of records, labs and two letters from my endo. They finally approved it (I have been on it 5 days now!!) I also told them I am thinking about gettting pregnant again. This is true and I think it might have helped alot.
Hi Mike, I’m about to send in my package of 1st appeal paperwork. Medicare BC/BS Advantage Plus.-Mich… Attempting to get Navigator. I feel I have gathered all information including medical studies printed from comp.
I don’t know what, not in this packege, I could include in a very possible second appeal. Was told by CGM person, Abbott, that never has Abbott (Navigator) been approved in Michigan by BC/BS… She also told me that my paperwork contents are very good. good. With my ever worsening Hypo. unawareness, I certainly need this.
Do you know of any 1-2 things that were what turned the tide for you.
Any help would be appreciated.
Jmi Devlin
After 4 attempts and LOTS of documentation for hypoglycemic unawareness, BCBS of ND has approved the CGM for my daugther as of last week. Keep trying. Persistence helped in our situation.
i have an appointment with a new endo in may and am thinking of asking her for a CGM recommendation. i have keystone health plan east (POS with the university of pennsylvania health system network) in philadelphia. i haven’t run into anybody with this plan, or even the keystone hmo, anyone out there?? thanks in advance!
