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How to get CGMS reimbursement

Insurance Companies

Regence Blue Cross Blue Shield of Oregon

Homepage on the web: http://www.or.regence.com/

Coverage - tbd

Plans (no data)

Group #s (no data)

No data yet on coverage amounts ($s).

No data yet from cgmscentral members concerning actual reimbursement from this carrier/plan/group.

Highmark Blue Cross Blue Shield

Homepage on the web: http://www.highmarkbcbs.com

Coverage - tbd

Plans (no data)

Group #s (no data)

No data yet on coverage amounts ($s).

No data yet from cgmscentral members concerning actual reimbursement from this carrier/plan/group.

Forum thread discussing reimbursement activity for this carrier was started by Staci http://www.cgmscentral.com/node/82

AETNA (Non-Medicare)

The latest home for the relevant policy is located here: http://www.aetna.com/cpb/medical/data/1_99/0070.html

Covered - Yes

The policy for coverage of CGMS by AETNA states that it is medically necessary given certain conditions like hypoglycemia unawareness, etc...

However, coverage is limited to no more than 2 monitoring sessions per every 12 months.

No data yet on coverage amounts ($s).

No data yet from cgmscentral members concerning actual reimbursement from this carrier/plan/group.

United Health Care (UHC)

Plan is the POS (but next year changing to high deductible plan with pre-tax Health Savings Account (HSA) to cover $4500 deductible then 100% covered.)

Group# is 226310: Delta Airlines Employee - Self-Insured Employer

MM looked into my insurance (UHC) and quickly came back that it is covered after my deductible at 80%.

UHC didn't seem to have any trouble saying it was covered. This includes the pump upgrade and all the sensors.

The problem I have is that MM says the pump upgrade is about $5000 minus $500 trade-in allowance. Then the CGMS is $1000 -

Blue Cross Blue Shield of Texas - Diabetes Policy

TEXAS: Diabetes. TexasAdministrative Code. Code Section 1358.001 – 1358.057 and 28 TAC 21.2601-21.2606.

BCBS Diabetes Policy

Excerpts: Contract:

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