I have a buddy I work with who has a child with T1 and he indicated his child was approved for the 670G, but disapproved for the supplies that it requires. Has anyone encountered this before? If so, have you challenged and won? What steps should my friend take in a situation like this? Also, yes, I’ve invited him to the forums - waiting for him to get around to accepting my invitation!
That sounds like when I was approved for Dexcom sensors and received them, but denied for the transmitter and receiver. It took me several months to sort out a clerical error I the part of the DME provider.
Something like this makes absolutely no sense, so I think the first place to start would be with the insurance company to see why it was denied. I would bet it is a simple coding error.
A couple possibilities. Certainly it is an insurance snafu of some sorts. How easy it is to fix depends on how the appeal was written.
Pumps have two components, each with unique codes - durable medical equipment (DME), with a specific code, and durable medical supply, with a different code. The pump is the DME, and the infusion sets are the supply.
Dexcom is similar - sensor, transmitter, and receiver I believe all have different codes.
If the initial request said something like - “request for a Medtronic pump and supplies…”, it is stating that both of them are in the request. So that would be easy to fix. You go back to the initial request and show that it was for both.
If the initial request only said “Medtronic pump” and makes no mention of the supplies, than you have to go through all kinds of hoop jumping and try to find a human at the insurance company who can use logic. Otherwise you are out of luck because they will say there never was a request for the supplies.
Anyway, I’d be happy to help if your friend needs it.
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