Hello everyone! I am very excited to be here!

"This letter is in reference to your appeal request for reconsideration of our denial of the above referenced claim (procedure codes A9278, A9276, and A9277)

Your appeal has been reviewed by our Medical Director, Dr. STanley E. Harri. The sensor and transmitter are consideered [sic] investigational.

Therefore, the above claim is not eligible for reimbursement.

We regret that a more favorable decision cannot be reached; however, benefits can only be extended in accordance with our established medical policy guidelines.

Sincerely,

[signed}

Paul Zoblitz

I already had a nice lady who called to get the authorization number and my new transmitter is in the hands of UPS! How great is that?

I read on another list that someone who works for an insurance company sites their guidelines for getting a CGMS as:

1. Type 1 DM 2. Test BS at least 4 times a day 3. Recurrent "severe" hypoglycemia of less than 50 mg/dl 4. Frequent BS above 150 mg/dl 5."Poor control despite compliance with frequent changes in the medical regimen." 6. Three or more injections a day or use of an insulin pump.

She continues:

IN TOTAL SHOCK!!!!!

I HOLD IN MY HAND, TEARS DOWN MY FACE AN APPROVAL LETTER FOR THE CGMS!!!!!!

I cannot believe it! No denial, no fighting, just as if 'Oh, OK, here"....

Faint: THUMP!

I have yelled out SO LOUD, the dang neighbour looked over the fence thinking I'd won the lottery, and in a way, I have!

OMG, I'm going to FRAME THIS LETTER!!

How cool is THIS???

My name is Lahle Wolfe. I am the founder of Islets of Hope and iPump.org, Inc., a diabetes, 501(c)(3), nonprofit assistance organization. I am actively involved in diabetes advocacy, including the cause of obtaining CGMS coverage at national level. Hopefully, my comments on this site will help others struggling with their insurance companies.

Is dying because of the short lifespan of the transmitter. Of course I had just ordered sensors for the thing, but am STILL waiting on insurance to say yes or no. It'll most likely be no, but I digress.... All I know is if I have to go into debt to get a new transmitter, I shall. I need this and it has saved me from no less than 4 lows at work in the last month.

My daughter has been approved for the Freestyle Navigator and I've just started a new blog where she and I can post our experiences. Feel free to drop by.

http://just-a-little-further.blogspot.com/

Mary C.

Does anyone have a list of medical providers that have approved a CGMS for continuous use as a medical necessity without having to get all kinds of documentation and a letter from your doctor?

We just got the Dexcom Seven CGMS and it is terrific. The site did not hurt at all. Darby said it was a lot like getting a pump site and no worse (we use the inset by Animas which doesn't hurt much at all). The sensor is so tiny it looks like a half inch long filament of metal about the circumference of a piece of string. It was so tiny, we were able to put it in her arm instead of her hip and save valuable real estate for her pump sites. It calibrated easily and stayed pretty true to her numbers (within 20% compared to the meter).

According to a filing with the SEC by DexCom and reported by Edgar Online, CMS published the codes this past Friday for submitting cgms claims. There are codes for the sensor, the transmitter and the receiver. See details as filed in the original request for the codes: HCPCS 2008 Request Pending for creating reimbursement codes.

Here's the catch.

For some reason everybody thinks that if you have dedicated codes that it will improve reimbursement for the new technology.

Wrong.