WOW to Minimed/other insurers

I already had a nice lady who called to get the authorization number and my new transmitter is in the hands of UPS! How great is that?

I read on another list that someone who works for an insurance company sites their guidelines for getting a CGMS as:

1. Type 1 DM 2. Test BS at least 4 times a day 3. Recurrent "severe" hypoglycemia of less than 50 mg/dl 4. Frequent BS above 150 mg/dl 5."Poor control despite compliance with frequent changes in the medical regimen." 6. Three or more injections a day or use of an insulin pump.

She continues:

"I don't know how the Appeals side of things work and how often decisions get overturned, but I do know the initial decisions are very much by the book--you either meet the criteria or you don't. Everyone has to be treated the same so adherence to contract and clinical and coverage guidelines is very tight. When I do denial letters I always spell this out so when the Dr calls back to do the peer to peer they know exactly what we're looking for.

I don't agree with the guideline on this one. I think it's just as dangerous to have high blood sugars all the time as to have those low ones which one must have to qualify but it is what it is. I do think that eventually the guidelines will not demand the lows be present but that's just my opinion."

I am so happy that mine went so easy this time. I was really getting set for war, but my insurance was so easy to work with. I think much of this was having the pump/CGMS company do the leg work for me. Wonderful service from both insurance and Minimed!