DexCom Sales Reps

link — Fri, 07 Sep 2007 21:13:51 +0000

Insurance Carriers Who Cover CGMS

link — Fri, 07 Sep 2007 21:13:21 +0000

Insurance Carriers Who Cover CGMS

link — Fri, 07 Sep 2007 21:13:21 +0000

How long have you been using CGM?

Sun, 06 Jan 2008 23:17:27 +0000

* 1-2 months * 3-6 months * 7-12 months * 12+ months

How do I go about obtaining insurance coverage for CGMS?

link — Fri, 07 Sep 2007 19:38:16 +0000

How do I go ...

Welcome to CGMS Central. Our mission is to be the resource on the web for anything about CGMS reimbursement.

link — Fri, 07 Sep 2007 19:53:39 +0000

Start a Forum thread for discussion purposes. Then, create a Wiki Page for documenting the factual information that the patient filling the claim needs in order to streamline the process (who did you talk to at the carrier? and what was their phone # or email address?) and ensure more successful claims.

If you are not sure where to get started with reimbursement, check out our FAQ.

We hope you join our community and help move CGMS reimbursement along.

CGMS Billing Codes

Lahle — Tue, 01 Jul 2008 15:10:45 +0000

If you do not use the proper billing codes, you can forget CGMS. When your doctor contacts your insurance company, be sure s/he uses the right billing codes.

A9276 for the sensor

A9277 for the transmitter

A9278 for the receiver

CGMS Billing Codes

Lahle — Tue, 01 Jul 2008 15:10:45 +0000

If you do not use the proper billing codes, you can forget CGMS. When your doctor contacts your insurance company, be sure s/he uses the right billing codes.

A9276 for the sensor

A9277 for the transmitter

A9278 for the receiver

BCBS of Michigan (MICHILD)

curtis596 — Sat, 26 Jul 2008 19:02:54 +0000

I just received reimbursement from BCBS of Michigan (MICHILD). I simply called and asked for the reimbursement form, filled it out and sent it in with appropriate documentation. At first it was denied due to lack of prescription, which wasn't so, so I faxed a copy over right away. Approximately a month later I got a check and a letter stating it was approved.

My reason....

johnp503 — Wed, 02 Jul 2008 14:39:15 +0000

I wanted the unit that I could move on with. I'm starting with the Medtronic Guardian. In the future I may have to progress on to a pump and Medtronic makes a pump which works with the sensor that I am currently using. Medtronic is the oldest company in the business so that is a plus also. johnp503

Blue Cross and Blue Shield of Ohio

WindyCobourne — Fri, 04 Jul 2008 18:38:27 +0000

I have not received reimbursement yet. My claim has been pending since January. I call about once every 3 weeks to check on it, so they have on record that I am being persistent. The latest is that it is under medical review and I should have an answer by July 17th, 2008. Currently all I have submitted is my letter of medical necessity from my endocrinologist. I will update when I hear results. If anyone else has had acceptance or denial from this same insurance company. Please share your experiences with me! Thanks!

Blue Cross and Blue Shield of Ohio

WindyCobourne — Fri, 04 Jul 2008 18:38:27 +0000

Disallowed by Horizon BC/BS of NJ: "investigational"

tedlevy — Fri, 11 Jul 2008 18:24:42 +0000

"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

Disallowed by Horizon BC/BS of NJ: "investigational"

tedlevy — Fri, 11 Jul 2008 18:24:42 +0000

"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

How long have you been insured by this policy?

link — Fri, 07 Sep 2007 19:54:05 +0000

...

Medical Plans that Approve CGMS

Steve The Diabetic — Fri, 25 Apr 2008 18:51:59 +0000

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?

California Blue Cross Blue Shield BCBS

Thu, 03 Apr 2008 16:37:11 +0000

What happened after Blue Cross rejected her daughter Laura's application for a continuous glucose monitor? Gillian Miller took on the big boys and won!

http://www.diabeteshealth.com/read/2008/03/26/5695.html

Resources

link — Fri, 07 Sep 2007 21:07:21 +0000

Clinical Studies Showing CGMS Outcomes

Insurance Carriers Who Cover CGMS

Doctors Who Prescribe CGMS

Sales Reps

Insurance Carriers Who Cover CGMS

link — Fri, 07 Sep 2007 21:13:21 +0000

CGMS on loan to me

Wyldceltic1 — Thu, 26 Jun 2008 21:02:54 +0000

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.

Medical Plans that Approve CGMS

Steve The Diabetic — Fri, 25 Apr 2008 18:51:59 +0000

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?

Welcome to CGMS Central. Our mission is to be the resource on the web for anything about CGMS reimbursement.

link — Fri, 07 Sep 2007 19:53:39 +0000

If you are not sure where to get started with reimbursement, check out our FAQ.

We hope you join our community and help move CGMS reimbursement along.

sensors for kids

kevin — Wed, 17 Oct 2007 14:53:03 +0000

We chose the Dexcom sensor primarily based on size of the needle. With kids who don't have that much body fat it has to be short and of course the smaller the gauge the better, too. By the way, it was funny to hear my daughter lay down her #1 requirement in no uncertain terms, "it has to have an inserter".

United Health Care (UHC)

kevin — Wed, 31 Oct 2007 16:04:11 +0000

Plan is the POS (but next year changing to high deductible plan with pre-tax Health Savings Account (HSA) to cover $4500 deductible then 100% covered.)

Group# is 226310: Delta Airlines Employee - Self-Insured Employer

MM looked into my insurance (UHC) and quickly came back that it is covered after my deductible at 80%.

UHC didn't seem to have any trouble saying it was covered. This includes the pump upgrade and all the sensors.

The problem I have is that MM says the pump upgrade is about $5000 minus $500 trade-in allowance. Then the CGMS is $1000 -

Highmark Blue Cross Blue Shield Forum

kevin — Fri, 09 Nov 2007 17:36:44 +0000

Originally posted on the Wiki page 11/8/2008 by Staci

Called Highmark today and gave the service rep the codes and she reported nothing on file yet.But she told me to call back at the end of December; there may be more information loaded. She said she was hopeful. I have PPO Blue with full Diabetic Coverage and for what I pay monthly I expect the CGMS to be covered and will fight for it.

Staci