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From: M on 1 Aug 2008 17:03
I need to get the name of a contact person in New Jersey who will assist
me in getting a claim processed for the �Medical Necessity� of the
MMT-7002C glucose sensor. Looking for a name in the state government or
at Horizon Blue Cross / Blue Shield
I do not wish to pursue this via email or telephone. I would like to
pursue this via the U.S. Mail.
From: M on 2 Aug 2008 14:31
M wrote:
> I need to get the name of a contact person in New Jersey who will assist
> me in getting a claim processed for the �Medical Necessity� of the
> MMT-7002C glucose sensor. Looking for a name in the state government or
> at Horizon Blue Cross / Blue Shield
> I do not wish to pursue this via email or telephone. I would like to
> pursue this via the U.S. Mail.

Dear Medtronic Diabetes Patient,

On April 4, 2008, Horizon BCBS of New Jersey decided to reverse their
coverage position on Medtronic Diabetes' REAL-Time Continuous Glucose
Monitoring (CGM) products. As you are aware, you had previously ordered
the transmitter and glucose sensor products from Medtronic Diabetes, at
a time when Horizon BCBS held that such products were a covered benefit
under your plan. As a result of this policy reversal, however, Horizon
BCBS is now requiring you to purchase these products directly from us as
a cash pay item (i.e., entirely out-of-pocket for you). At Medtronic
Diabetes, we believe these products should receive appropriate coverage
as an important, medically necessary component that is very beneficial
to your overall health care. Therefore, we are working closely with
Horizon BCBS to re-establish a policy so that these diabetes products /
supplies are once again covered.

Specifically, we believe that Continuous Glucose Monitoring Products
bring great medical value to persons with diabetes, and that this
adjunct therapy to self-monitoring and maintaining beneficial A1c levels
is critical to reducing long-term complications brought on by diabetes.
Studies have shown that CGM can reduce the incidence and risk of
hypoglycemia while lowering overall glucose values.

As a consumer of health care from Horizon BCBS, you have the ability to
contact the medical policy team or Horizon's customer service, to
request that these products be a covered item under your plan, based on
the clear health benefits you have seen in your diabetes control. If you
have benefited from CGM and would like to contact the plan to raise your
concerns, as is your right as a consumer, the contact infonnation is below.

Attn: Medical Policy Director Horizon BCBS of N] Three Penn Plaza EAST,
PP09P Newark, NJ 07105-2200

Also, you can call the Horizon Customer Service Department and request
the opportunity to appeal their coverage decision on CGM. The phone
number for your specific benefit plan is located on the reverse side of
your Member ID Card.

Lastly and importantly, you can also engage the support of your
physician who can call 1-800-624-1110 and/or write to your insurance
company (addressed to Appeals Unit, Horizon BCBS of NJ, P.O. Box 10129,
Three Penn Plaza East, Newark, NJ 07101-2200), to explain the benefits
of CGM in more detail and support their coverage under your plan.
Because your physician has observed the benefits to you personally from
using CGM products, he or she is in a great position to explain to
Horizon the specific clinical benefits ofCGM. Thank you in advance for
your interest and support in this most important initiative. Through
your efforts and the support of your physician, we are optimistic that
there will be an opportunity to re-establish a Medical Policy Coverage
for REAL- Time Continuous Glucose Monitoring products.

Please feel free to contact us with any questions, at 800-646-4633.
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