Anyone been through the CGMS application process wih Aetna?


(jdeaver) #1

I’m about to start the application paperwork process to add CGMS to my Medtronic 722. Is anyone has already been through this process with Aetna, I am interested how it went. Any suggestions would be appreciated.

Thanks


(Gina) #2

Yes, I have it is a really long process it took me a year to get approved a lot of persistence and fighting but it is well worth it in the end. Also call up Minimed directly and tell them because they got involved in the end and it was then approved in less than a week.

 


(A-D) #3

Joe,

I am about to get started with Aetna (seeking the Navigator).  I can tell you my approach and promise to keep you updated as I go.  I think things may be easier for us than they were for Gina as Aetna changed their CPB (Clinical Policy Bulletin) back around June of this year.  I just switched endocrinologists or I'd be a little further along.  The CPB is at: http://www.aetna.com/cpb/medical/data/1_99/0070.html and I think it is worth a review.  You'll note that hypoglycemia unawareness is one of the hot buttons so, assuming it is true, I would make sure to list it... :)

Given everything I have read, I would expect a denial and be prepared to appeal and to be persistent.

I will keep you posted on my progress.  I meet with my endo on Monday... Good luck to us all and I will be grateful if you keep us up to date on your progress...

Cheers!

A-D


(halfshadow) #4

Hi Joe,

My daughter's CGMS was approved by Aetna in late September.  Aetna is her secondary insurance and after a long battle with the primary insurance (and 4 denials) I was expecting another war but Aetna approved with no appeals.  We only had to get the letter and back up from our endo.

I was told by our Medtronic rep that they are seeing a lot more approvals from Aetna since the JDRF study was published in early September.

Good Luck!


(Kelli0922) #5

I just went through this. My Aetna is through a CDHP, but apparently most Aetna plans work the same.

Call your Minimed rep and call them often until you hear that they have received the form from your doctor with the specific diagnosis code on it. They should know which one and apparently only one code works. Once they submit that, call Minimed's 800 number and check on the status. This will let you know who your rep is on the Minimed Insurance side. Ask them to expedite the request. Call Aetna and expedite your request as well. If you do all of these you should (per what I was told) have the CGMS within about 2 weeks from when the form from your doctor was submitted. Mine took about 30 days from the correct form being submitted by the doctor, but that was because I didn't know I needed to have the request expedited from both sides.

Once you hear you have approval ask who your trainer will be, if you don't already know. They can set-up an appointment based on when your supplies will arrive.

Good luck and have patience. It has helped me to feel like I can live life again.


(DocHam) #6

I have. Its pretty easy. Call the insurance liason at Medtronic and they'll give you the specifics but Aetna will need a letter of necessity from your physicians, several month logs of your blood glucose levels (just a download from your glucometer) and then I think you fill out some paperwork for Minimed.

 

It went really well. Since I've met my deductible, I've been getting free system and "bought" a whole new system since mine's out of warranty free of charge!!! So post-haste - you want to get it submitted before December 31st!