Diabetes Technology Blog

Working to get coverage

I've been using a Dexcom continuous glucose monitor for nearly 18 months now. In all that time I haven't been able to get my insurance company (Aetna) to cover the costs. I just heard from Dexcom that Aetna has made them a provider, though there are still many hoops to jump through before I get reimbursement. I'll post with more details once I have those.

Most (all?) of us with diabetes have been denied coverage for thing needed to maintain control of our diabetes. In fact, insurance coverage for chronic illnesses is fairly bad in the US (and often worse in other countries). Today the Wall Street Journal published a short article on getting coverage, Pushing Back When Insurers Deny Coverage for Treatment.

They've provided a list of things you can do to improve your chances of getting insurance to cover treatment.

1. Find out what led to the denial
   
2. Learn how to appeal the denial
   
3. Take detailed notes, including dates and names, when you talk with the company
   
4. Get a copy of your plan's detailed benefits language (Evidence of Coverage)
   
5. Find out what they consider to be medically necessary

Sometimes I've talked with insurance companies to find that the doctor's office has used the wrong diagnostic code when submitting the claim. Often the insurance company will even tell you which code they should have used, or which codes they've used in the past.


Persistence pays off in some cases, like the parable of the persistent widow. Just remember to be polite to the person you speak with at the insurance company - they're generally following rules and are usually helpful. And many situations are open to interpretation.

Have you had things that were denied that you managed to appeal successfully? What approaches worked for you?

Labels: appeal, coverage, insurance, wsj

posted by Bernard @ 9:58 AM