[Diabetes-talk] Help for those denied CGM coverage.

[Bridgit Kuenning-Pollpeter]

Joyce,

That's insane you have been denied. Just shows that insurance companies
don't really care about patient care.

You definitely seem to qualify for this program for CGMs.

Bridgit

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
blindhands--- via Diabetes-Talk
Sent: Thursday, September 29, 2016 10:15 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: blindhands at aol.com
Subject: Re: [Diabetes-talk] Help for those denied CGM coverage.

I do not feel insulin reactions at all.  I have been trying to get to the
kitchen to get juice and walked out my sliding door , falling down the steps
and breaking my wrist.  The Twenty years back within 18 months I had 2
silent heart attacks and didn't have a clue I had them.  Second one I had
shortness of breath walking in the hall I worked at.  I have had diabetes
for 57 years.

My family has found me passed out on the floor with estimates of me being
there 3 to 4 hours.  Since my husband died 2 years ago things have gotten
worst as I am home alone most of the time.

That is why I fought to get a CGM to go with the Meditronic  insulin pump
and received 3 denials.

Joyce

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Robert Shelton via Diabetes-Talk
Sent: Thursday, September 29, 2016 9:32 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Robert Shelton <rshelton1 at gmail.com>
Subject: Re: [Diabetes-talk] Help for those denied CGM coverage.

Are you sure? I ask because my wife is usually able to tell if she is going
low, even at night while asleep, but if she doesn't catch it in time, then
she's helpless. I've been working on her to get the CGM. It's not going to
replace testing, but it covers those times when you should test and for some
reason, don't. 

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Bridgit Kuenning-Pollpeter via Diabetes-Talk
Sent: Thursday, September 29, 2016 5:24 PM
To: 'Diabetes Talk for the Blind'
Cc: Bridgit Kuenning-Pollpeter
Subject: Re: [Diabetes-talk] Help for those denied CGM coverage.

I went to the site and found the rules for those interested. Based on this,
not just anyone qualifies. For me, for instance, will not, especially with
number one, I have no problem knowing when I'm low:

1.Have diabetes requiring multiple daily injections or insulin pump therapy
with hypoglycemia unawareness (the inability to recognize when your blood
sugar is too low).
2.Have had private health insurance coverage for CGM before transitioning to
Medicare.
3.Have been denied coverage for a CGM by Medicare, filed a request for
redetermination (the first level of appeal), and been denied again.
4.Be able to include a copy of the redetermination decision letter from
Medicare denying the first level of appeal.
5.Have a physician willing to sign a statement of medical necessity 6.Have
medical records that can be submitted in support of the Medicare appeal if
requested.
7.Agree to have their favorable Administrative Law Judge decision shared and
added to the administrative record on appeals. The purpose of this request
is to send a message to Medicare that this is an important issue and affects
many people.
8.Have gross annual pre-tax household income below the median income in your
state for a household of the same size. 


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