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.

CIGNA covers Navigator for adults and children at 90%- USE EDGEPARK!!!

Mon, 04 Aug 2008 00:36:51 +0000

CIGNA just approved my daughter who is 7 for the Navigator and they are paying 90% of the unit and the sensors through Edgepark. We originally had tried this through Smith's Medical directly and they told us CIGNA wouldn't cover it, but Edgepark had no problem getting it approved. They were quick and effective and we had to do nothing other than fill out the paperwork and submit the prescription. No fighting with CIGNA, etc.

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.

Sales Reps

kevin — Fri, 05 Oct 2007 03:00:49 +0000

MEDTRONIC DIABETES 800-646-4633

www.minimed.com www.medtronic.com

information: www.minimed.com events: www.minimed.com/events/ real diabetes control: www.realdiabetescontrol.com training: http://pumpschool.minimed.com supplies: http://store.minimed.com kid's education: www.PumpExpeditions.com

Dexcom (need info)

Abbott Diabetes (need info)

Breaking News: CGMS Coverage in New York

Gina — Wed, 23 Jul 2008 14:25:27 +0000

If you are a New Yorker and have been denied coverage by insurance or would like coverage for the Continous Glucose Monitoring systems I have great news.

A friend of mine spoke personally to NY State Assemblyman Robert Sweeney tonight. Here is what transpired.

Welcome to CGMS Central

link — Thu, 06 Sep 2007 18:59:18 +0000

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

Our goal is to provide you with the tools and tips that you need to get reimbursement for your CGMS.

To do this, we need your help:

Share your experience getting (or trying to get!) reimbursement in the forums.
Start a blog about your personal experience getting reimbursed

The battle begins

iamdiabetes — Wed, 16 Jul 2008 15:20:38 +0000

Hello everyone! I am very excited to be here!

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

WOW to Minimed/other insurers

Wyldceltic1 — Tue, 08 Jul 2008 13:06:28 +0000

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:

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!

APPROVED!!!!

Wyldceltic1 — Fri, 04 Jul 2008 18:23:00 +0000

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???

Sensor Length

Thu, 03 Jul 2008 09:47:51 +0000

I bought (read no reimbursement) the Dexcom CGM because the sensors had the longest life.

What do other people say about CGMS by vendor solution?

link — Fri, 07 Sep 2007 19:59:11 +0000

DexCom - Their new DexCom Seven system (featuring a 7 day sensor and water resistance) came out in Spring 2008.

Medtronic - Medtronic's new 522/722 insulin pumps are now equipped to receive input from a separately purchased system called the REAL-time CGMS also from Medtronic. I don't know if they are continuing manufacture and support for the Guardian RT CGMS.

Abbott (launching in Europe) (pending FDA marketing clearance in the USA - Not for Sale)

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

Medtronic Guardian Sensors

Wed, 02 Jul 2008 14:25:35 +0000

I have had a sensor last as long as 27 days. I do have to charge the transmitter every 6 days. Right now I only use them for 12 days. I start with a new sensor and let it run till I get "Sensor End" alarm and then I just start it as a "New Sensor". At the end of 6 days I remove and charge the transmitter and again start it as a "New Sensor". johnp503

How to Contact Lahle Wolfe for Help

Lahle — Tue, 01 Jul 2008 15:21:56 +0000

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.

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 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.

CGMS Denial Day July 1, 2008

Gina — Wed, 25 Jun 2008 03:09:23 +0000

I am officially dubbing July 1 as CGMS DENIAL DAY.

Me, along with many others are sick of being denied coverage for the CGMS. Join me on July 1 to raise our voices as a community.

If you have been denied coverage for the CGMS by your insurance company, Please make a post on your blog, personal website and or a video post wherever you are a community member on JULY 1, 2008 telling everyone how important the CGMS is for you to keep healthy.

New Freestyle Navigator Blog

dragonblimps_mom — Mon, 26 May 2008 07:34:55 +0000

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.

Diabetes Technology Design Collaborative

Wed, 14 May 2008 20:34:03 +0000

Enhancement to the SMART INSULIN PEN originally published by John Walsh

This wiki is based on the design of an insulin pen which also includes many additional capabilities. Starting from this premise (a universal blood sugar management tool for people who use insulin therapy), this page can be used to document a series of modifications and enhancements to the original design.

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

HCPCS 2008 Request Pending for creating reimbursement codes

kevin — Tue, 18 Sep 2007 21:24:39 +0000

Attachment #07.32

Request to establish 3 new codes for continuous glucose monitoring systems. Suggested Language: (1) “Sensor, invasive (e.g. subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, each”; (2) “Transmitter, external, for use with interstitial continuous glucose monitoring system”; and (3) “Receiver, external, for use with interstitial continuous glucose monitoring system”

http://www.cms.hhs.gov/HCPCSReleaseCodeSets/Downloads/2008RequestList.pdf

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

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