Sunday, February 05, 2006

Health Insurance situation
Jenny says:

The Guardian RT was approved late in 2005, so for insurance purposes, it hasn't even been assigned an insurance code. (Someone told me that new FDA things get insurance codes only at the beginning of the year.) So, I believe that there will be a more aggressive attempt to get the device and the strips covered by insurance in 2007 when they have a code.

I have had one brief conversation with our insurance company, and they told me that I should just have my endocrinologist send a letter of necessity and go from there. I have asked Tommy's endocrinologist if he could send one and really emphasize hypo unawareness. (Tommy does not wake up when he is low at night. ) I am not guessing that it will be covered or that it would be retroactive. But, I am still going to try. I believe that it can't hurt to start letting insurance people know about this life changing device.


Sandra Miller said...

Interesting that your insurance company still encouraged you to send the letter of necessity-- despite the fact that an insurance code is not yet assigned to the Guardian.

I'm really hoping that there's some way around this code issue (my understanding is that insurance codes aren't given until a product has been in wide release for at least 6 months prior to when codes are assigned-- in January -- thus, the earliest the Guardian might see a code would be January '07).

In the meantime, I'll be keeping my fingers crossed as we await hearing of your insurance company's response.

Mike said...

Minimed has a whole department that just deals with insurance company claims on behalf of their customers. It would be interesting to call them and find out if one of these claims has ever gone through.

Shannon said...

I caught sight of your blog via Sandra's blog. I like that this blog will be from a child's perspective as well. Welcome!

Anonymous said...

Hello Tommy and Mom,

Thanks for sharing your experience... my daughter is a Type 1 and is 8 years old.. she was dx. Feb. 2005. We'll check this site often :)


Anonymous said...

I am praying for the insurance to come through for you. Particularly if you are experiencing hypoglycemic unawareness and going low at night, I'm hoping in those instances insurance would cover the Guardian. It's been tested and it works. We chose another pump because we were told it would be years before the FDA would allow the Guardian to be used on children. Maybe Tommy can help speed up the process.