[Previous Months][Date Index][Thread Index][Join - Register][Login]   Help@Insulin-Pumpers.org
  [Message Prev][Message Next][Thread Prev][Thread Next]   for subscribe/unsubscribe assistance

[IP] Re: (IP) Medicare coverage of CGMs

That's fantastic news and is an excellent result! One thing to know - there
are two types of coverage determinations resulting from appeals decisions
against a MAC (Medicare Administrative Contractor or "payment contractor") -
local coverage determinations and national. There are 13 MACs in the country
by region, so if it's a local determination it means it only applies within
that MAC and people in other regions whose Medicare is administered by a
different MAC are out of luck. However if it's a national coverage
determination then all MACs in the Country must follow it. I have not yet
looked at these links yet (but I intend to)B so I don't know if it specifies
whether it's a local or national determination. However it's good news in any
case and can definitely be cited by people appealing in other regions. Love
the judge'sB name :)Pam
<Here is some very good news. An administrative law judge (ALJ) from the
Medicare Departmental Appeals Board, Civil Remedies Division, has essentially
thrown out the CMS argument that CGM equipment is non covered because it is
PRECAUTIONARY! The case was brought against NHIC, a Medicare DME
contractor, and the Center for Medicare Services (CMS) that used Policy
A33614 to deny CGM coverage. Judge Keith W. Sickendick, his real name, has
issued a preliminary decision which will become final when CMS fails to
medical documentation for the ridiculous NHIC policy article issued more than
ten years ago.

 Dr. Nick Argento, an endocrinologist from Maryland, has supported several of
his Medicare patients in their efforts to obtain CGM coverage. If anybody
to try you may use this case when your claim is denied by Medicare and/or
private health insurance plan. Here is the link to Dr. Nick's website which
includes several other important links.>
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org
Follow us at https://www.twitter.com/insulinpumpers
Make a long URL short at http://type1.org
Donate with every purchase http://smile.amazon.com/
(select your charity = Insulin Pumpers)