My insurance will not cover the CGMS.

I talked to the rep. at Medtronics, who by the way, I have dealt with before and she is a lovely person.

Her name is Molly and she has been diabetic all her life and she just started on the CGMS and she absolutely loves it.

We talked about how we have such anxiety as we no longer can recognize highs and lows and how she gets all nervous and not sure if it is a low or just being nervous and unsure.

I told her how I am afraid to move sometimes, doing stairs, or long hikes, because of fears of lows and she stated she was testing almost 15 times a day.

I am contacting my insurance company tomorrow.

Karen

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If you read the FDA approval of the Medtronic Minimed device at http://www.fda.gov/cdrh/PDF/p980022s011b.pdf , and the read the 3rd sentence of the 1st paragraph of section II, titled "Indications for Use", you'll see the following sentence:

"Values are not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a finger prick may be required."

This sentence is why insurance companies don't pay. From their perspective, they cover and encourage the finger stick thing, therefore an instrument that indicates a finger stick may be required is not necessary. It is up to the manufacturers of the devices to get the FDA to sign off on this device being used instead of finger sticks, rather than in conjunction with. Don't blame the insurance company, blame the manufacturer who didn't get the approval to replace finger sticks, or of course the Republicans who run the FDA ;)
I realize it is still in its early stages, but I feel like my life is passing me by because of my diabetes, sometimes I am afraid to move. Hypoglycemic unawareness and tighter control with the pump has made my bgs better but not my freedom to do what I want when I want. Hard for me to explain, but my life was easier when I was on two shots a day and kind of in the dark about things. With tighter control comes hypoglycemic unawareness and therefore my need and want of the CGMS even if I still have to test my bgs manually occasionally. I know the device will improve over the years, but I don't have any more years to wait.

Thanks for responding and I do understand all sides.
I understand your point, I am a Type I and have had some whopper low BG's. To be clear, I am on your side. Unfortunately, these devices do not yet have the FDA sign off required to push the insurance companies to do the right thing.

Again, dang Republicans, holding back stem cell research as well as CGSM, next thing you know they'll ban insulin for 1) being against God, and 2) not promoting enough health insurance industry profit.... (My humor may be a bit odd -- I hope you realize this is a poor attempt at political humor!)
I understand your odd humor. ;) and I understand why insurance co.'s are not jumping on the bandwagon with the CGMS, but they will.

Glucose meters used to cost $300.00 and now you can get them for free, so I am sure the price will eventually go down, but I don't want to wait. I have had diabetes for 40 years and have only been pumping for 4 and now regret that I was such a chicken $#i+ for waiting to try the pump. I don't want to wait on this.
My insurance company currently pays for 400 test strips a month for me. I would gladly take 100 strips and the CGMS. Even if the CGMS numbers aren't exact, you still get the trends and can tell if you're going too low or high.

I thought that insurance isn't covering it because there are no proper billing codes yet. Insurance companies use the codes that Medicare uses and since Medicare doesn't cover CGMS systems, there are no codes yet
Hi everyone! I am new to the website. My son is 6 1/2 and was diagnosed January 22, 2007. He is curremntly a "pumper" and everything seems to be going well. My wife has quit her job and started a new one as a full time pancreas for Caleb. He attends a private school without a nurse so my wife has become his caregiver at school as well. I just wanted to say "hi" and get aquainted with the website.

So far, everyone we have come in contact with who has diabetes or knows someone with diabetes has been so supportive. That includes Molly at Medtronic. She has been very helpful in getting started with the supply side of things. I also grew up with a girl who had diabetes, She is actually the one who recommended this site. It means so much to know that yo are not alone when you are new and dealing with your own emotions, your spouses emotions and your childs emotions. I hope to learn a lot here and would like to be able to offer that same support to anyone with a child who has diabetes. Thanks for allowing me to join in.

Brian
Good luck with the battle with Aetna. I haven't even tried going through Aetna ( my insurer) for the sensors yet. Since 2000, Aetna has supplied me with a Minimed 508 and a 512 & the supplies with a minimal co-pay. I decided about 3 or 4 months ago to bite the bullet and just buy an upgrade to the 522 pump and the Transmitter/sensor kit. I have paid too high a price for too many lows. I wanted a better way to live.

So far with the sensor, it's always warned me before low blood sugar gets to be a problem I can't take care of. One thing I learned "very unofficially" from my pump trainer was that many, many users switch sensors after 6 days, rather than 3 days. Instead of a box of 10 sensors lasting me month, they last me two. That was a very nice surprise.
if you check out yahoo group diabetescgms - there is a person on there that got Aetna to pay for the MM CGMS -she has an HMO - 100% DME coverage.

Dexcom filed my claim with Aetna this week Choice II PPO - 90% in network coverage/70% out of network coverage - i will try to keep the group posted...
Thanks for the update, and my reply from Aetna was not that they would not pay, but they look at each case, and they hope that I was not doing it for things to be easier(no finger testing). After they read my letter, I think they will rephrase their terminology.
I got lucky, in that my insurance company Blue Cross/Blue Shield WAS approving CGMS for everyone, until they abruptly changed their stance on this in June 2008. (I got the pump/CGMS system a few months earlier.) I do wear the MiniMed, and I do well by it. I also live alone, and have had diabetes close to 40 years. I have no hypoglycemia awareness left. Frankly, I would use a CGMS even if I had to pay for it out of pocket. I am frightened to sleep at night without one. I know that some Aetna policies DO cover CGMS, but apparently yours doesn't. I trust that, in time, after endocrinologists see the positive changes in people's BG control, they will force insurance companies to pay for them. (However, ObamaCare may stop them!)

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