Replies to This Discussion

Permalink Reply by MrsGink on March 8, 2012 at 6:55am

BCBS in NJ is no longer covering sensors unless you have a documented low that required medical intervention, e.g. ER visit, doctor verified seizure, glucagon use followed by ER visit. It stinks because they used to cover it and this change seems to go contrary to medical practice -- use a CGM to stay away from the ER!

Permalink Reply by John on March 8, 2012 at 7:11am

BCBS MN tried to deny me--I managed to overcome their decision by noting:
1) that I had been a diabetic for 50 years, and that I was suffering from hypoglycemic unawareness;
2) waiting until I had suffered a loss of consciousness was essentially as you have described it--I was required to suffer a near-fatal experience before the device would be allowed. This made no sense.

My case was reviewed by a physician (rather than a businessman), and the decision to deny me coverage was overturned. I was, however, warned about the BCBS lifetime limit on coverage. (Thank you, Affordable Healthcare Act!)

Permalink Reply by carb101 on March 8, 2012 at 7:30am

Interesting how much BC/BS varies. Although we live in Texas, my husband's employer is based in California, so we have BC/BS of CA. We had to work our way through a vareity of appeals to get the CGM, but it really wasn't "hard"; it was time consumming, but more for the MD and the folks at PumpsIT than for me.

Permalink Reply by TrueTheory on March 8, 2012 at 1:29pm

I go through Diabetes Specialty Center out of Utah. They have fantastic customer service, quick shipping, and always include receipts. 1-800-775-4372

Hope this helps!

Permalink Reply by metheniac on March 8, 2012 at 3:39pm

We must all keep in mind that insurance companies (in general) are out to make (or at least save) money. Many of the adjusters who review our requests for medical supplies do not have the education to practice such demanding tasks. It took me over a year of appeals and finally a third party judgement to get a CGM! This was after I had many hypo episodes and one really bad one that should have killed me. It is a long story, but the short version is that I lost consciousness due to a related problem, fell and broke my neck at C2. I should be either dead or paralyzed, but was fortunate to get really good, care - so I am neither. Blue Shield of California still denied me a CGM and after the fourth appeal, I applied for a third party medical judgement and won!
So the moral of this story is: don't give up. Keep writing to your insurance and have your doctor do the same. If we all just accept their (sometimes) lame answers...we will all be in trouble.

Permalink Reply by Jay on March 11, 2012 at 9:01pm

As far as Federal BCBS is concerned, the company that processes the claim is the one in CA where Dexcom is located. The CA BCBS will contact your BCBS franchise company for coverage verification but the claim is still handled in CA.

I was initially set up with Edgepark, but they are very nit-picky and I would not buy alcohol wipes from them, I would get rubbing alcohol at Walmart and use cotton balls instead.

Permalink Reply by Carolyn A. on March 22, 2012 at 4:18am

I use Edgepark and they are really easy to work with.

Permalink Reply by Benjamin McLaughlin on March 22, 2012 at 8:12am

BCBS in LA denied me first off, saying that they require a pump therapy in order to receive a CGM. Pumpsit then put in for an Omnipod and the Dex, and within a weak of the original denial, I was approved 100%. I am with OGB, so I guess I am lucky. I never thought about how important it is to have a job with OGB and good insurance until I was diagnosed. I am a teacher/hopefully college football coach. Whatever happens I have to stay on a group plan, so I can't get hit with the pre-existing condition.

Pumpsit for me, did a fantastic job. No hassle for me, they took care of everything. I will make a few phone calls every 3 months to place an order after I saw how hard they worked to get me what I needed.

Permalink Reply by smileandnod on March 27, 2012 at 9:29am

This is interesting because I have insurance through BC/BS of Louisiana and am required to go through PumpsIt for my sensors. Originally I got my Dex and start up kit with sensors directly from Dexcom but then our insurance plan year changed and BC/BS began requiring us to go through PumpsIt for the Dexcom and Diabetes Management Supply for the OmniPod. I think it makes no sense for me to have to use 2 different 3rd party suppliers but I do it because I have no out of pocket cost so I'm not complaining.

When I get my Dexcom sensors from PumpsIt, I get 3 months supply. With my shipment comes an invoice/statement showing a zero balance owed. They also send a sheet for me to fax back to them that gives you the option of having the same order automatically shipped to you the next time with the caveat that you should call if there are any changes to your order. The whole process is effortless for me.

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