Tuesday, October 27, 2015

Medicare and CGM's

I have an MVP health insurance plan. It is affiliated with Medicare, so MVP must follow Medicare rules. Dexcom tried to get their CGM approved for me. It was denied. My endo then presented a letter of medical necessity to MVP, mentioning my hypo unawareness. I was turned down again. Here is the explanation from MVP for the denial:
"Per the MVP Policy Continuous Glucose Monitoring long-term continuous glucose monitoring systems beyond 72 hours (A9276, A9277, A2978) are not covered for Medicare products. Therefore the request is denied."
The denial is not very well worded. I think they are objecting to a device that is used in the skin for more than 3 days. An infusion set for a pump is usually recommended for 2 days, but many of us use them for 3 days. So MVP/Medicare approves pumps and infusion sets. A CGM sensor is recommended for 7 days, and many of us use them for 14 days, or longer. That is much longer than the 3 days approved, so MVP/Medicare denies coverage of a CGM.
I wonder why having a sensor in my skin for more than 3 days is considered inappropriate by Medicare. Does anyone know?

2 comments:

  1. It's actually not the "three days" they are objecting to. It is another carefully worded statement. Your doctor can put a loaner CGM on you (it is usually blinded so the patient can't see the results but the doctor can analyze back in the office after) and insurance will cover that. Insurance will approve that three day experience. SO... basically, they see the value of CGMs and using them to help you understand your BGs but not enough to actually pay for them. :)

    ReplyDelete
    Replies
    1. Thanks, Sara. I had not heard that explanation.

      Delete