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BC/BS Massachusetts New CGMS Policy

Doris' Blog
By: dorisjdickson

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Posted: Aug 17, 2009 14:58
  • BC/BS Massachusetts New CGMS Policy

    Effective June 1, 2009 BC/BS Massachusetts has changed their CGMS policy.  It is a policy change.  It is NOT plan dependent.

    They will cover (with doctor's recommendation) CGMS's without contortions for diabetics.  It is no longer dependent on the things like 1) seizures 2) passing out 3) ER visits 4) gastroparesis, etc.  They are covered period.

    However, they are covered under durable medical equipment which tend to have a limit on them.  My old group PPO which is considered to be the cream of the crop and that I was paying $445 a month for had a $750 annual maximum - obviously not enough to pay for a CGMS or a pump.

    The choices that I debated this time (as direct pay) were PPO/$1,000 deductible - $1,500 annual durable medical equipment max and the one I chose HMO Blue/$500 deductible - $750 annual durable medical equipment max.

    So the good news is they changed the policy; the bad news is coverage is nominal at best. 

    For those who have had their CGMS and pumps paid for/reimbursed, what category were they on your insurance plans?  What amount for the initial equipment?  What amount thereafter?


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  • By: FatCatAnna: Aug, 18, 2009 22:17 PM

    Hey Jazzsushi!

    Are you serious that you don't know what you fork out for your insurance at work?  I know when I was working fulltime (only work part time at the moment) - I had to know exactly what I was paying and covered for as money was tight.  If I had to pay a deductible for diabetic supplies - e.g. I had bought an air gun at one time - then something like that meant it was only covered 80%. 

    For my pump purchase - which was $7K - I had to pay 20% of the purchase price as the insurance only covered 80%.  I considered what I had to pay extra as the "best birthday pressie" I would have for the next 10 years.  It's the only way I could justify buying a pump.  Luckily, I managed to get my supplies for the pump at 100% - generally it's 80% coverage.

    BTW, how are you finding the Omnipod compared to the Paradigm (I did a trial run with that one and the CGMS for 4 months before testing out a Animas 2020 - which I now own)?  I'm amazed that your insurance company paid for another insulin pump (tubeless) within such a short time.  With my insurance - I'm allowed to purchase a new insulin pump every 5 years - tho' you never know - they could change their mind in a blink of an eye!  You know those companies - got to make a profit off of us.

    By: : Aug, 17, 2009 17:58 PM

    I have Harvard Pilgrim (New England) and I really don't know what I pay.  I used to use the Medtronic Paradigm which had a CGMS component.  I signed up for it and I don't know what category is what on my plan.  My insurance premiums are auto-deducted from my paycheck...so I'm not sure.  It got covered and I used the pump for a year, before switching to a "tubeless" insulin pump, the Omnipod by Insulet. 

    Blue (1) HMO (1) equipment (1) medical (1) PPO (1) durable (1) Massachusetts (1) CGMS (1)

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