Denied and I didn't even try!
heres the email I sent to my insurance company and their response. I am denied!
3/17/2009 10:34:10 - Dear Sarah:
Thank you for the inquiry concerning the predetermination submitted. We have carefully reviewed your policy and found that the proposed procedure is excluded under your coverage agreement. No benefits are available for continuous blood glucose monitoring system.
If you have any further questions or concerns, please contact the Customer Service Department at 1-866-536-4541 between the hours of 8:30 a.m. and 6:00 p.m. Central Standard Time or via Blue Access.
Sincerely,
Jennifer C.
Blue Cross Blue Shield of Illinois
Customer Service Center
-- SARAH CONDON - 03/16/2009 12:29:53 -- I was wondering if my coverage will cover the costs of a continuous blood glucose monitoring system. How much would I have to pay out of pocket?
3/17/2009 10:34:10 - Dear Sarah:
Thank you for the inquiry concerning the predetermination submitted. We have carefully reviewed your policy and found that the proposed procedure is excluded under your coverage agreement. No benefits are available for continuous blood glucose monitoring system.
If you have any further questions or concerns, please contact the Customer Service Department at 1-866-536-4541 between the hours of 8:30 a.m. and 6:00 p.m. Central Standard Time or via Blue Access.
Sincerely,
Jennifer C.
Blue Cross Blue Shield of Illinois
Customer Service Center
-- SARAH CONDON - 03/16/2009 12:29:53 -- I was wondering if my coverage will cover the costs of a continuous blood glucose monitoring system. How much would I have to pay out of pocket?
Replies to This Discussion
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Permalink Reply by Yvonne on -
Ah, Blue Cross Blue Shield. The same company that says I should only test my BG two times a day. But, I bet they're more than willing cover the costs of complications . . .
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Permalink Reply by Cynthia F. on -
Blue Cross is the same ones that said I could have a "breast augmentation" covered.... but couldn't have but a select few amount of strips a day.
Gotta love their double standards!
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Permalink Reply by Sarah Kay on -
i get 250... I test 8 times a day, of course I have a small copay... like $30 for all my pump supplies, test strips, and lancets
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Permalink Reply by Cynthia F. on
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MelissaBL sent me some information to get a prior authorization override for strips - I will find it and send it to you.
I now get 400 strips a month
I have BCBS and they did end up covering my CGMS
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Permalink Reply by Sarah Kay on
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oh I replied to their email asking why! I told them they'd be saving so much money since complications from lows and highs cost a lot!
I asked them what I need to do to have it covered.
I demanded an answer and also mentioned that if thats how its going to be, I'll gladly switch insurance companies next open enrollment.
ill hear back in 2 days
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Permalink Reply by cdw on -
I have blue cross and they covered mine on the first try. Must depend what level of policy you have?
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Permalink Reply by Sarah Kay on
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oh they just made me mad, so now Im determined to fight them. I will get a monitor.... they dont know who they are messing with
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Permalink Reply by Sarah Kay on
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3/18/2009 7:32:25 - Dear Sarah:
Thank you for the opportunity to assist you with your recent inquiry regarding eligibility of benefits for continuous blood glucose monitor.
We carefully considered your request but found that based on the information you provided, a continuous blood glucose monitor would not be eligible under your health care plan.
In order to receive a pre-determination of benefits, please have your physician submit a letter of medical necessity to the address below including the applicable procedure codes to be performed.
Blue Cross Blue Shield of Illinois
PO Box 805107
Chicago IL 60680-4112
If you have any further questions or concerns, please contact our customer service department at the toll-free number on the back of your Blue Cross Blue Shield identification card or via the Message Center on Blue Access.
Sincerely,
Shanda B.
Blue Cross Blue Shield of Illinois
Customer Service Center
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Permalink Reply by Greg on -
Yeah, this sounds normal. Like you said, you were denied before even trying, and it only counts as a 'try' when your doctor submits the letter of medical necessity. There is a lot of information here on getting approval if you need it.
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Permalink Reply by Chadd on -
After missing another day of work due to a low that brought on a migrain, I had contacted my diabetic educator to go forth on with the processes with getting approval. All information is being sent to MiniMed and their handing everything. (Not sure if this is standard for everyone) I was quoted the prices. Starter Kit after insurance would cost me $91.41 and the sensors a month would cost me $33.33 a month. Was told insurance would cover 90% of supplies. I was told I have good insurance, I had replied back, itwould be nice if the insruance would just cover services and expenses if needed.
So now, I'm in the waiting game of seeing if I'm approved or not. I really don't have much hope in the insurance company. Why - Our CEO at BCBS was fired and was awarded a severance package of 2.2 Million dallors. http://www.inforum.com/event/article/id/233829/group/home/
If they deny, I wonder if that would be a good reason to throw that in their face!! Haaa haaa.
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Permalink Reply by BBach on -
They may be a very large, very significant company, and therefore, your comments would just be looked at and disregarded. I would change to a different insurance company, if it's possible.
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Permalink Reply by Jess on -
Did your doctor send in a letter to them or did you just request the info for yourself? I know with my Blue Cross(not bcbs of Illinois) they must have a note of medical necessity first before they even consider coverage, and so far they have covered everything for me. I'm not on a CGM, but my doctor wants me to go for one in the fall when I'm back home. So I won't know about that coverage till then. Hope it works out!
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