Insurance covering sensors?

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Permalink Reply by Michele on January 19, 2009 at 10:28am

Hi Kay, Noticed your post of last March and was wondering if you ever were able to get Kaiser to cover the sensor. I have started to have lows in the night and would like to get on the sensor. As of 6 months ago Kaiser Southern California did not cover them.

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Permalink Reply by Joanie on January 25, 2009 at 10:13am

Kaiser of Northern California won't cover mine. I'm really frustrated

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Permalink Reply by Donna Heun on January 24, 2009 at 12:37pm

Sorry you never got any help with your question? Are you still in the battle or did you win? Hope you won and insurance is coverina your sensors. United Health Care paid covered mine but as of January first, the hospital I work for switched to CIGNA. We will see if they will cover them for me. I sure don't want to be without. They have helped me so much to get better control overall and keep me safe from lows I no longer sense.

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Permalink Reply by TeJay Gould on March 18, 2009 at 7:33pm

Kay,
I'm on BCBS insurance. They paid for my Dexcom back in 9/08 and my first box of 4 sensors. Then they denied the next 3 months supply of sensors. They reviewed my case but didn't realize that they had already paid for the Dex and sensors. I finally got an answer. They said that they made a mistake in Sept. I appealed the decision and was told two startling things. At present the CGMS are investigtional and not approved by the FDA. Secondly the use of interstitial fluid as a means of reading blood glucose is not reliable and does not improve blood glucose control. I really don't like it when they don't tell the truth. All we can do is continue to fight them I guess with kind letters.

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Permalink Reply by Al Dupuis on March 25, 2009 at 4:15pm

Kay, I have bcbs and the cover my sensors 100% and have been doing it for two years. Al.

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Permalink Reply by type1steve on March 29, 2009 at 2:34pm

I have United Health Care PPO, they cover the transmitter and sensors 100% (after $200 deductable for the year is met) under durable medical equipment. Needed a letter of medical necessity from my diabetes endo and 2 months of blood sugar results. Minimed folks handled the whole paperwork process for me (have MM 522 /w CGM).

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Permalink Reply by David Vale on March 31, 2009 at 6:39am

Kaiser is now in the approval process to cover CGM. According to my physician, they will cover a CGM and sensors under the durable medical supplies category. They will only cover type-1 diabetes, your physician must recommend it, and you must have visited you Endocrinologist at least three times in the last year. He also told me that they will likely cover the Lifestyle brand of CGM so if you use another, good luck, I use the DexCom although honestly, even though its sensors last for weeks, the receiver is junk and DexCom doesn't back its products. If you plan to buy a CGM from this company, keep that in mind. My receiver failed two months after I purchased it and the replacement ten months after that. The support person kept having me reset it until it failed completely just a few weeks after the warranty expired. How convenient for them. Now they want $800 to replace it-it is now a paperweight and I have $300 in sensors. The transmitter lasts for one to one and one-half years and when it needs replacement, budget another $400 to 500. DexCom been steadfast in their warranty denial and I suspect that they may be in financial difficulty. I will not replace my CGM until Kaiser makes an exact decision of what they will cover and for how much. That is expected in the next week or two.

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Permalink Reply by Betsy Whitehead on April 21, 2009 at 5:07pm

I have Kaiser multi choice (Georgia) and am battling them now to get coverage for CGM & sensors for MiniMed paradigm. I was told that there are 5 criteria for submission and coverage. A few of these being that you must have seen 3 diabetes healthcare providers within the last year, at least 3 blood sugars below 49 within a two week period, a recommendation or referral from your physician that you need it. I don't remember the other two but I do know that they only are concerned with hypoglycemic episodes and not hyper. Kind of crazy since they are equally lethal! I will let you know what happens. At least they have come up with criteria.

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Permalink Reply by Joseph Boyd on June 18, 2009 at 8:29pm

We just got our Guardian CGM from MiniMed and undergo training tomorrow morning. My insurance is Humana (PPO) in Texas and they approved both the kit and the sensors. Good luck fighting them! Mine was pretty easy, but I think it is because of my sons age combined with his lows. 3 1/2 and is not great at telling us about how he feels yet, so ,... you know how it is...

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