Missouri Medicaid and CGM


(Amanda ) #1

Does anyone know why Missouri Medicaid (Missouri Cares) won’t pay for a personal CGM? It’s very frusterating that they won’t and this may help me prevent lows and highs with the alarms.


(Sal) #2

Will they pay for the Medtronic 670 and CGM combo?

I know some insurances won’t pay for a standalone CGM, but will pay for the combo.


#3

Amanda
How old are you again?
I want to say 13/14, am I right?
I think you are having a hard time because of a few things but then again it may vary by state.

Typically to receive a cgm, you need a pre authorisation. To get that pre-aut from your insurance it usually requires a few things.

  • to see an endocrinologist ( typically once or twice a year)
  • to be testing several times a day (between 4 & 8 depending on the insurance)
  • type 1 diabetes
    And some times more requirements.

Do you see where your issue is?
You have mentioned in the past that you do not have an endo but only a pcp.

Also, medtronic cgm is not approved for under 14. You are left with the only Option of the dexcom ( which is a great option)

I’m not familiar with Missouri care however most insurance does approve an endo. It often requires a referral from your pcp to an endo already approved/covered by your insurance.
Is there an adult that could help you navigate through?


(Amanda ) #4

Emet @Emet
I am 13. I don’t have an endo because the one I had was out of state and when medicade switched to Missouri Cares, they didn’t cover anymore.


(Amanda ) #5

No. They won’t pay for a combo-- I don’t think.


#6

@AAT1D
They may not cover the one you had but it doesn’t mean you can’t get a new one who would be covered by them now.


(Dennis J. Dacey, PwD) #7

Amanda @AAT1D, currently there are not any laws that require insurance companies or government agencies to pay for medical devices. Not even insurance policies for which people pay hefty premiums nor Medicare for which people are required to pay premiums for sometimes 45 or for years before receiving any benefits.
Just over a year ago CMS - Medicare approved payment for CGM devices for beneficiaries who met certain requirements [but not for all beneficiaries with diabetes]; to receive CGM PARTIAL reimbursement, the endocrinologist must certify approximately twelve questions about the patient including a patient’s dedicated attempt to manage her/his diabetes.
The Medicare cooperation was achieved by successful lobbying of congress for several years - bills died in several sessions of Congress [each session lasts for two years] before finally being adopted by the 115th Congress. A lot of effort by many people and organizations, including JDRF.