Continuous Glucose Monitor


(lohara) #1

Does anyone have a CGM and if so, how did you get insurance to pay for it? I have BCBS and they will not pay for a CGM or for the coveted Medtronic insulin pump as they say they still need to be researched. I am going to Italy for 2 months to work at a summer camp and will begin teaching Kindergarten in August. I desperately need a CGM to catch my lows and highs. In case you don't know what it is, it is a device that tests you blood every minute and alerts you if you are getting low or high.  Please help if you can!!!

Lauren


(Dwight Elkin) #2

There is a secondary insurance that not alot of people know about. it is called Gateway. You should look into it. It doesn't matter your salary. You will have to feel out forms and go from there. Get intouch with jdrf and they will give you the information. Good luck.


(joe) #3

Lauren, consider an appeal with Blue Cross.  They are currently paying for my pump, my supplies, and I just got approved for a CGM...  completely covered between BCBS and my prescription plan (and DME equipment plan)... something isn't right here.  Pumps are widely approved for years now and CGM are becoming more and more easily obtainable.  Most of the time you need an Endocrinologist to prove you need a pump, a GP or internist is not good enough.   Dop you have a script for these items?  Sometime an appeal will make all the difference.  Consider threatening them with a lawsuit too, sometimes that helps =) . 


(devynsmom) #4

I definetely agree with Joe here consider an appeal. My sons was covered 100%. Good luck, although I must add, we stopped using the CGM because it wasnt all it was cracked up to be for us! Keep in mind the CGM's are about 20 minutes delayed and it wasnt consistant for us.. but good luck to you!


(amc253) #5

Hey Lauren.  I have been on a Minimed since last November and BCBS covered (most) it with no problem.  I still have to pay quite a bit for supplies though.  I have also been on a CGM since Febraury.  My request was denied the first time, but then my endo wrote a specific "letter of medical necessity."  They have a general form letter, but BCBS wanted a specific one for me before they would consider covering it.  My local Medtronic rep said that I was the first BCBS of KC sensor candidate to be approved. 

I absolutely love my CGM.  I really don't know what I would do without it now.  It does give delayed readings sometimes, and once in a while it is no where close to being right, but most of the time it has been pretty close.  Since starting the CGM, I feel that I have better control because I always know about where I'm at.  If my CGM says that I am too high, but I normally wouldn't do a finger stick for another couple hours, I can catch it sooner and bolus to bring it back down.  I'm expecting my next a1c to be much better and I will attribute it to my CGM.  It has also saved me from what could have been some severe overnight lows.

Hope this helps.


(memery64) #6

I was wondering the same thing, Lauren. I just got Health America Insurance and my doctor told me that they DEFINITELY won't pay for one and that I shouldn't even bother. I might just go ahead and try anyway.  I have nothing to lose and everything to gain if I get one.  I hope you get one Lauren.

Hugs,

Marcie