Aetna Approves CGM Coverage

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Permalink Reply by Jeff on March 31, 2008 at 9:01am

Thanks, Mollie-we are considering getting a CGMS for our Son, Aaron, in the next year or so. Hopefully, by then it will be covered with no problems, thanks to trailblazers like you.

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Permalink Reply by Jenny on March 31, 2008 at 12:26pm

What GREAT news! And thanks for the spreadsheets which may help others to persuade their insurers too.

Best of all, it's wonderful that the CGMS helped you make such a huge improvement in control.

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Permalink Reply by Tammy on April 4, 2008 at 12:16pm

I am about to send my second appeal to Aetna for the CGM for my 16 year old daughter. I hope that they approve this one, if not I am not sure where to go from here. Thanks for your info, I am going to attach her readings on a spreadsheet like you did.

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Permalink Reply by Karen Doering on April 4, 2008 at 4:35pm

Lordie, I went through my appeal process with my previous insurance and won, and this your our insurance changed to Aetna and I just ordered more sensors last night, hope Aetna pays, ahhhh!!!!

Medtronic rep did state to me back in December when I won my appeal that she had a special deal with Aetna and there would be no problem, hope she was right.

Hey I still have the email, this is what she said:

Also, for ongoing sensors orders, Donna stated that as of January 2008, claims will be going through a different processing office. Just FYI, when you do need to reorder sensors, we will probably have to contact the new claims office, which is through Aetna. We do have single case negotiated contracts for sensors through Aetna, so when it comes to new sensor orders, the process won't be the 6 month headache you've had to go through.

Crap I did not contact the claims office, now what will happen, guess I better on Monday, or perhaps not, just wait it out and see if they pay, grrrr.

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Permalink Reply by Steve RRR on April 4, 2008 at 4:50pm

Thanks, Mollie. I am covered by Aetna as well.

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Permalink Reply by Mark H. on April 6, 2008 at 9:45pm

Great news Mollie!!!

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Permalink Reply by Mollie on April 7, 2008 at 6:32am

Not sure exactly what the last sentences mean exactly---also my second claim was only covered at 70%---but Aetna's policy was updated recently to read as follows...

Continuous Glucose Monitoring Devices:
Aetna considers continuous glucose monitoring devices (e.g., MiniMed Continuous Glucose Monitoring System, Guardian Real-Time Continuous Glucose Monitoring System, and the DexCom STS), which are used to continuously monitor diabetic persons' blood glucose levels over a three-day (72-hour) period, medically necessary for persons with type 1 diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
repeated hypo- and hyperglycemia at the same time each day; or
hypoglycemia unawareness.
No more than two CGMS monitoring periods are considered medically necessary within a 12-month period. Aetna considers the long-term use of continuous glucose monitoring devices for home self-monitoring of blood glucose experimental and investigational.

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Permalink Reply by Karen Doering on April 7, 2008 at 9:17am

Crap this is not good for me. :( Just when I won my appeal through my old insurance they changed to Aetna, and now I am using the CGM a lot.

I am sad. :(

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Permalink Reply by Mollie on April 7, 2008 at 9:23am

it could be just the standard that they are starting to approve without appeal for the 2 sessions...maybe if you appeal and get your letters from Dr and show hypo unaware, dawn phenom, fluctuating glucose, they will continue to pay...i am sending my 3rd claim in later this week...will keep you posted.

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Permalink Reply by Karen Doering on April 7, 2008 at 3:54pm

This is the response from my medtronic rep.

Hi Karen,

Still here; I was promoted to a new department, but can still assist.

I would definitely suggest contacting Aetna to see where claims are sent. When you start your reorder, let me know and I will contact the
representative on the Supply Order team to explain the authorization.


Man I already ordered just thinking I could since I was with same company and my medical ins. previous appeal would still continue. I am stupid sometimes when it comes to all of this red tape, this is almost harder than having the darn disease itself (not really of course), and the anxiety I have now, ahhh!!! and I found out that they are no longer making freestyle flashes and my meter is old and I have a mega supply of strips, ahhhh!!!!

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Permalink Reply by Mark H. on April 7, 2008 at 5:23pm

So are all of your sensors being covered?

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Permalink Reply by Karen Doering on April 8, 2008 at 7:23pm

Mark not sure who you are questioning but my old insurance was covering 100% on sensors, not sure Aetna will do the same. I think I spend money every day on diabetes. This disease is far too pricey and I am also paying with my life as I sit here most of the day above 180 and now over 240 and cannot figure out why except the little bit I did eat was always on a bit of a high. Seems once you go high and eat you cannot get it back down. :(

Ready to pull both my sensor and my pump sites out in a minute, I am soooo upset.

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