Determining if your health plan covers the therapy you need is important to managing your diabetes. If your plan decided not to cover certain medications or aspects of your therapy, there’s still a chance you can get coverage. This guide was created to help you request access and understand your options.
Click below to access the guide.
I have a Medicare advantage plan United healthcare. I had been getting enlite sensors from Medtronics and now I’m being told they are not being covered because of Medicare guidelines. Is there anything I can do? I have had lows in the middle of the night and it would be really helpful if I have a sensor. I would like to go to Guardian 3. Thank you, Kathy Moodie.
Unfortunately Medicare does not approve Medtronic sensors as they are less accurate and still require testing your blood glucose with a meter before making diabetes decisions. Currently only Dexcom and the Abbott Libre are approved, so hopefully you can work with your provider to obtain one of the devices that is covered.
I have an Advantage 65+ Plus thru Blue Shield. I receive my health care at UCSD. Dexcom has not made the G6 available for Advantage 65+ Plus patients. I am paying out of pocket for these. I have read the CMS publications that state Medicare is covering Advantage patients with the same benefit at Part A,B Medicare patients. Yet I have been unable to use this Medicare Benefit.
In July 2018 I was approved for G6 to be covered by Blue Shield 65+. I dutifully paid my co-pay share. Then in early December I received a letter saying that I was not being covered as an Advantage member. I filed a claim with Blue Shield who again denied it , but I followed up with more copies of CMS information releases. As of March, they have paid the insurance share of 2018 my Dexcom G6.
The frustration is I am now buying them over the counter, pricey but available. I was certified eligible for the Dexcom G6 CGM by my endocrinologist at UCSD. Blue Shield says they are still checking into this- are they? Who really knows. The head of the BS Advantage claims department says the denial is based on an IPA manual they use for coding.
Please tell all of us Medicare patients on Advantage plans what is going on! Or, if you are not aware of this, I need the name of a strong advocacy group for Type I diabetics who are on Medicare and not receiving our covered DME.
You may want to reach out to an attorney named Debbie Parrish in Pittsburgh for the latest information regarding this issue. We worked with her for a time, and she specializes in Medicare cases regarding CGM. Her email address is: firstname.lastname@example.org. At the very least she likely knows the best advocacy groups to contact.