[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] Anyone's insurance paid for the 522 with RT monitor yet?



 I just wanted to share my experience with insurance appeals and codes. We do
not have a CGMS for our son but I plan on applying for coverage/appealing later
this year. I've already got the appeal written!
   
  My daughter was born with bilateral cleft lip and palate and we had great
difficulty getting our insurance company to cover dental procedures directly
related to the cleft palate. Once we proved medical necessity in the first
appeal, they used a miscellaneous code since they did not have one for some of
the covered items.
   
  If you can prove medical necessity for CGMS in your appeal, which, in my
opinion, is pretty cut and dried, then they can find a code for coverage.
Sensors are simply test strips. Transmitter/receiver is simply a glucose
monitor. The have different shapes but they are the same in function. My policy
specifically states that test strips and glucose monitors are covered
prescription drug products. If your insurance currently covers test strips and
monitors, then remind of this.
   
  Eventually they will have specific codes for sensors and transmitters but the
lack of them should not prevent us from fighting for coverage.
   
  Good luck!!
  Becky
   
   
   
   
  Reply:
All of the pumps are covered by most insurance companies. The Sensor kit is
what the insurance companies are not covering yet. The 515 pump and the 522
pump have the same code #.
Phyllis *************************

  Without a CPT code ("insurance number"), exactly how, pray tell, do you
  expect your insurance company to reimburse or pay for this expense?

  > As of last week, Minimed thought they were about a year away from
  > getting an "insurance number" for billing.


 		
---------------------------------
Do you Yahoo!?
 Everyone is raving about the  all-new Yahoo! Mail Beta.
.
----------------------------------------------------------
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org