AskNadia: Getting Anthem Health Insurance to Cover Medtronic’s 670G Insulin Pump Supplies

This column is a request from people and families living with Type 1 diabetes, that is dealing with an insurance company that refuses to adopt industry standards, by paying for insulin pump supplies like their competitors for a medical device upgrade. The upgrade from the Medtronic 630 G insulin pump and supplies to the 670 G pump, offers no additional cost to the insurance company.

You can support your fellow Type1’s by calling and emailing the press people from both companies; requesting a resolution for the long list of families who are caught in an administrative snafu which is not being addressed.

The Anthem press person is Olga Gallardo and you can reach her at 818-201-5682 and the Medtronic press person is Janet Kim and you can reach her at 818-403-7028.

Dear Nadia:

Anthem is the only national insurer not covering the new Medtronic 670G system, which is a major step forward in diabetes management. As you may know, Medtronic promoted the system through its Priority Access program, which urged families to pay nearly $4,000 from their own pockets to get the 670G system first.

Because Anthem refused to cover the system, Medtronic now won’t ship the 670G systems to these families who purchased the system because Anthem won’t cover the supplies needed for the system.

Medtronic requires a letter from Anthem saying it will cover the supplies – a request that Anthem customer service reps and supervisors don’t even understand because the 670G is not on their formulary.

Families usually just go through the appeals process to get Anthem to cover the supplies, they can’t: They have no denial of coverage because Medtronic won’t ship them the 670G system. With no new system, there are no new supplies and no denial to appeal.

Whether Anthem subscribers can get the money they’ve already spent refunded is an open question: Medtronic actively solicited them to buy the 630G pump system to qualify for the Priority Access program for the 670G. The upgrade to the 670G was just $299 – so most of the nearly $4,000 they spent is for a pump they’re now using, the 630G, but probably wouldn’t have bought without the promise of the 670G’s benefits. Getting a refund for a pump and CGM you’ve been using for months will be tough. See the information here. Medtronic does say the coverage is reliant on insurance coverage.

We understand coverage is often denied because of the increased cost of a new technology. But the 670G uses the same supplies as the 630G pump that Anthem covers – with just one notable exception, the CGM sensor. Medtronic insists that the costs for the 670G pump, CGM and supplies are the same as the current 630G pump and CGM supplies. Given that the costs are the same, this refusal to cover the 670G system is baffling.

In case you are wondering which companies cover the Medtronic 670G system, we compiled a list for you:

Aetna

Blue Shield of California

Blue Cross Blue Shield of Alabama, Florida, Illinois, Massachusetts, Michigan, North Carolina and Tennessee,

Cigna

Highmark

Humana

Independent Blue Cross

Source: JDRF

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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About Nadia:

 AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2017 by Healthline and with 19 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.

Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.

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