CGM approval


(A Magg) #1

My son is approved by his Dr. for a CGM. They sent a template wanting his BG numbers for 6-8 times a day for a month. He has been challenged with testing/high blood sugars for years which is the whole point for him getting a CGM (he tried it and it really helped him). He doesn’t test more than 3. Wondering if anyone has an opinion on this. Will he still be eligible with just 3 or 4 tests a day?


(Sal) #2

Call your insurance anonymously and ask them if this is a requirement and if they would cover it if you only check 3-4 times a day. If they say that it is, maybe check 6-8 times a day for a few weeks and then send that in, but make sure your approval doesn’t expire by then.


(Ryan) #3

I’m assuming it is your insurance company that wants these numbers and not your dr correct? We went through something similar when our kids got their CGM’s. Our endo knew it would be a huge help to us to get a CGM since we were trying to manage 2 young children with diabetes. I think our insurance company required 6 results a day for a month and at least 2 follow up visits after their diagnosis before they would cover a CGM. I can’t recall the exact reasoning but it basically boiled down to “red tape” to validate it was a medical need. Like you, our kids mainly only tested at meal times and before bed, with the exception of a low that required additional blood tests using the 15:15 method. Our doctor was great about helping us navigate the process and used our ER visit to count as one of the follow up visits, and subtly hinted at “filling in the blanks” to meet the insurance company’s requirements for testing. There’s no reason they needed all of the numbers other than to check off a box before covering the CGM, so rather than continuing to wait, we “filled in the blanks” for any tests we fell short on for the previous 30 days. Never had an issue and their dexcoms showed up within a week…

Hope this helps and good luck!


(Dennis J. Dacey, PwD) #4

Hi @amagg, I expect that you speak with your child’s doctor and find the reason.
Not knowing anything about his application and the doctor’s prescription I’d tend to think “medical necessity” especially if there is a third party payer. I know the processing of my prescription has taken two months and required that the endocrinologist complete a two [at least] page prescription form and the supplier had to see my medical records - I’m in my late 70’s and Medicare is one of the insurers for which I pay premiums.
Every three months I need to bring a printout of BG Check results to my doctor visit to document that I check my BGL at least eight times every day.


(A Magg) #5

Thank you for all the responses. It makes sense that the insurance would be the ones needing this info. We will do what we can!
Thank you!


(Chris - Pumper - T1D - 670G User ) #6

I just got put on the 670G system with the CGM, I was in a similar situation I was terrible about testing myself. The thing that got me to start testing more and more was just keeping in the back of my mind just how much the new system would change my life. From prior to the 670G my sugar averaged 190 to 230 and now its right at about 130 after only 3 weeks of use! Keep on him about testing, get that CGM and just watch your life get 10X easier I promise you that!


(Nancy) #7

@amagg - Granted it was nearly 10 years ago I got my first CGM, but I received mine without the ‘requisite’ number of tests/day. I don’t know anyone who actually does 6-8 (what a PITA!) anyway, but I liked @Christopher.Vance’s mindset - when you have a goal, you can do almost anything to achieve it!

BTW, @Christopher.Vance, how is that 670?

My best in health,

Nancy


(Chris - Pumper - T1D - 670G User ) #8

Absolutely love it, saved me from going to high or to low so many times!


(wyowiseguy) #9

Ask your doctor if maybe starting with the Freestyle Libre could help. It’s easy to use and get 10-12 readings daily without having to do any finger sticks. It will give trends whenever he does a reading. I know it’s not a CGM with alarms and all like the Dexcom, but it could be a good place to start. Also, it’s comparatively cheap even without insurance


(A Magg) #10

Well he got it his Dexcom G6 & still uses his Minimed pump. I have to be very careful when I ask anything re: diabetes after our years of hovering. Now he tells me he turned off the alarm that keep going off! Sigh…he does say that it is helping but I really don’t know what that means. Your post is encouraging @Christopher.Vance because he runs higher than your numbers and has sturggled for years. The motivating factor right now is drivers license AND he had a recent scare & finally started taking his lisinopril and lipitor regularly (yes he’s had some proteins in kidneys and high cholesterol). I hope for the day when he starts taking care of himself through diet and exercise.