Today I got a call from Edge Park saying I was denied by my insurance company for a Dexcom CGM. On account of me not being on a pump! However, if my insurance company APPROVED my Omnipod and I already have it (but can't start it yet unfortunately due to training and my schedule- but THEY don't know that!) then wouldn't they know that I AM on a pump??? This is a little ridiculous to me. So we have to appeal my claim once I start on the Omnipod- I'm not sure whey Edge Park just can't go back and say I do have a pump- they said they were going to wait 4-6 weeks before appealing. I think that is weird since I've had my pump for weeks now and my insurance company would know that!

Thanks for reading my vent =)

I want my CGM soooo badly!

Views: 16

Tags: CGM, Dexcom, appeal, insurance

Comment by Kristin on April 27, 2009 at 11:16pm
How frustrating!

Hopefully they will approve it once they realize that you do in fact have a pump (yes, it's crazy that they don't realize that now!!!)
Comment by Yvonne on April 28, 2009 at 7:07am
Well, I wouldn't wait for the insurance company to figure things out. I'd call your customer service rep and see what's going on.
Comment by Marina C on April 28, 2009 at 10:28am
that is actually a good idea!
Comment by Jill Knapp on April 28, 2009 at 3:44pm
Reps are wonderful and always willing to work with you. I was in the medical field for yrs and the first thing we would tell some one is call your Rep!!
It helped me when I had a broken ankle and they did not want to pay for my bone stimulator. Give this a try.
Good luck!!
Comment by Marina C on April 28, 2009 at 4:10pm
do you mean the insurance rep or the omnipod rep? Edge Park was the distributor and he was the one that said he'd try again in 4 weeks- why not now?
Comment by MelissaBL on April 29, 2009 at 8:01am
I hate feeling stuck in the middle between my insurance, my doctor's office, Edgepark, and the pump/cgm company. I feel for you. Here's what I went through last year.

In July, I put in to my insurance for a pump and a cgm. By the end of the month, I was wearing my new pump. It was August when the cgm company called and said it was approved by my insurance. In mid-September, Edgepark told me the package had shipped. Yay! Then, nothing ever came. In mid-October, my insurance let me know they'd actually denied it that month, saying that October was the first they had heard about it, and that neither Edgepark nor the insurance had received the required medical necessity documents from my doctor (which had been sent THREE times to both). As you can imagine, I was frustrated. Why had the cgm people and the edgepark people been telling me that everything was fine?

I finally won when I stopped allowing them to play middle man. I talked to a very frustrated CDE at my endo's office who gave me the direct extensions to someone at Edgepark, someone at Abbott, and the woman at my BCBS who had denied the claim. I called the insurance person and got a magic 10-digit pre-authorization code that I then shoved down the throats of the other two companies to make them get on the ball. By early November, I had my device.

So, I guess my suggestion is, like Jilly said, talk to a rep. But see if you can get a hold of the person who is personally responsible for denying your cgm. If you can fax THAT person proof of pump ownership (a photo of the serial number of the device, a packing slip, a receipt, etc), then maybe you can get a magic code. Be prepared for a lot of "this is a doctor's only line - why are you calling? - we can't give you this information." If you have your dates & ducks in a row, they'll listen.
Comment by Marina C on April 29, 2009 at 9:14pm
Thanks for the advice! I called my insurance company today, and talked to someone who sent me to the clinical appeals area. They are already working on my appeal instead of me having to wait for Edgepark to contact them 30 days later! woo-hoo! They say it might take up to 30 days but that is 30 days earlier than if I had done nothing :)
Comment by Jill Knapp on May 2, 2009 at 3:04pm
I am so glad!! It may speed things up and yes when I worked for the Dr. I heard of some people taking only a week to get approved and going!! :-
Comment by Marina C on May 6, 2009 at 8:33pm
I got a call saying I'm APPROVED!! yippee!!!
Comment by Kristin on May 7, 2009 at 10:28pm
Hoorah! Keep us posted when you get it and start!!

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