Why Insurance Companies Deny CGM Devices?

A couple of years ago I fought with my insurance company for months and eventually gave up. I thought it would be a Godsend for me because I live alone and have hypo unawareness.

Now, the environment has changed drastically a month ago in Ontario. Because we have socialized medecine, the government foots the bill for doctor visits, hospital stays, surgeries, etc… After a thourough study they discovered that diabetics cost the health care system more than any other group.

As of Sep 1, any resident of Ontario who has type 1 can receive a no charge pump from any one of 4 manufactures (Medtronic, Animas, Deltec Disetronic and MiniMed) as well as $200 per month to help pay for supplies.

The program does not include the CGM but in a few years I believe it will. Right now my insurance won’t cover the CGM so I have to pay for it myself, but they do cover the cost of all supplies.

Many insurance companies will cover the cost of pumps but in order to do so they increase the cost of the premiums to a rate that is stupidly high. A couple of years ago I tried to get some private health insurance to enable me to get something like this … until I saw the rate they wanted to charge … $700+ per month (a lot of that is due to my age (57 now)).

I feel terrible for those that pay insurance premiums and get denied. What’s the point of having insurance if the company picks and chooses what they will cover.

Hello,

I was searching for information on the internet, how to win an appear for the CGMS and came accross your letter. I have been on the sensors now for 6 months and now CIGNA has denied them. I am looking for sucesses and wondered if there was a way you could share some of your non-personal data so that I can submit my appeal to CIGNA. I have been a diabetic for over 38 years and next to the pump (which I have been on for 23 years) the sensors have been a live saver. So much in fact, that my kidney damage is reversing itself.

Thank you very much in advance.

Mary
St Petersburg FL

I have also appealed my insurance company (a Medicare Advantage Plan) for coverage of the Dexcom CGM system. My insurance agreed to cover my supplies March 2015 & then August 2015 denied my refill of the sensors. They told me they were coded incorrectly and should never have been covered. I had an appeal with the insurance company itself on Nov. 19, 2015 and was DENIED because they follow Medicare guidelines. However, the pharmacist that works for the insurance company & is brought in for appeals, stated that “Medicare is behind times & is always chasing the ball. For many years they did not cover insulin pumps either and most likely down the road when there is a new, more effective discovery that will help diabetics, then Medicare will consider covering the obsolete treatment.” After my insurance company DENIED coverage, they then send all documentation to Maximus, which is the Federal Medicare Appeals Reviewing agency. Maximus agreed with my insurance company & also DENIED coverage. On 2/25/16 (next Thurs.) I have an ALJ Hearing (Administrative Law Judge) via telephone. I live on Social Security Disability because of my vision impairment as a result of Type ! diabetes that I have had for 41 years. I do not have legal representation because of the financial burden I would incur (and frankly, if I could afford an attorney, I would be using the money to buy the CGM supplies!) I printed out the case of Whitcomb Vs. Burwell & submitted it as part of my case, but does anyone else have other legal cases that could help or any other recommendations? Thank You!

i am new to this please let me know about pay plan