Thursday, July 10, 2008

A Loop hole in getting a CGM approved!!! Try it :)

Well, I really am thankful to have good insurance that has covered , my son's supplies to date. They don't always right off the bat, but they do eventually.

I had a little help from a few key people before submitting my claim for my son's Dexcom CGM.. Here is the important key points to remember:

CGM's are new and may have caps (Such as $80 for users life in reimbursement) but as diabetics we have more of an unlimited resource for "Durable Medical Equipment (DME)" (Specifically over $399) (This is what I learned from the fine print) Sowwhen you file= remember= APPLY FOR COVERAGE WITH COOPERATION FROM YOUR ENDO FOR COVERAGE FOR YOUR DME (They will know the CODE for this) and the sensors should be claimed under the same diabetic injectables supplies that your pump sets or needles would be covered under.

Work as a team, and I know that Dexcom will work with you to get the approval.. we are still waiting, but have not had denials so far, and are waiting to get approval. We filed for reimbursement in May of this year... They have 45 days supposedly... but we have our fingers crossed, and I hope that the "check is in the mail!" so to speak! :)

If you need further info or specific codes because you don't have a saavy provider, please comment or email me, and I would be happy to provide these, I just don' have them on hand as I blog tonight :)

The CGM has been amazing for awareness for us all, and really has helped with allowing us to see trends most importantly...knowing that he is going up or down from even a great number, helps us to 'keep him in range' with foresight and insight.. rather than constantly reacting and having him bounce up and down like a ball in a box!

Good luck - and may the force be with you!

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