Insurance Coverage for CGM


(dsinclair) #1

Hi All,
I am currently sparring with my insurance company to get coverage for a CGM (Dexcom G5). My request has been denied once already and my doctor is resubmitting the request again (Hypo unaware). I will keep trying till they get sick of me, lol. In the meantime. I have looked into the cost of paying for the CGM on my own. As you would expect, the initial outlay (although expensive) is doable. However, the monthly upkeep makes it unaffordable.
I have researched myself stupid trying to find either a supplemental insurance to cover such expenses or any other alternative to make this happen.
I can’t be the only one who has this issue. I thought maybe we could all “brain storm” ideas for the financial upkeep of supplies without insurance.
Thanks in advance and I look forward to “meeting” you all.
Diana


(a_lada_life) #2

My insurance company initially denied my CGM. I requested their criteria and their determination. It turns out I met all the criteria except I didn’t submit evidence of low under 50. I appealed with some lows in the low 50s and emphasized that some arbitrary number shouldn’t be sufficient to deny something that has long term health benefits. I also pointed out that meters are only 80-85% accurate and so my low 50s should be close enough. Needless to say my appeal was approved. Good luck with yours.


(dsinclair) #3

Goodonya! I think I’ll plug that line into my request too. You are absolutely correct of course. Seems to me that if your doctor is the one pushing you to get it because you can’t sleep through a night without setting your clock to wake you up ever hour on the hour to be sure you are in the safe zone, then the insurance company should not be dictating what is a medical necessity.


(vasuzie) #4

Well, here’s some good/better news for Medicare patients…according to Dexcom, as of last week, Congress has approved Dexcom for payment under Medicare. Dexcom did not know particulars, as in how much will be paid, but put me on their list to receive updates. AND they are sending me a receiver free of charge (they promised - not here yet), but not reimbursing for the 8 sensors I purchased the week prior. So things are looking up. 2015 my out of pocket prescription costs were >$7,000 including Medicare and Dexcom, 2016 being determined. Any help would be great.


(vliekgo269) #5

I have Medicare and have been going threw the same thing. Medicare is going to cover CGM, but it probably wont happen for a couple of mounths


(laradittman) #6

I would call the insurance company and ask them their specific guidelines to be approved for the CGM. Write down what they say, word for word and make sure that is in your request (word for word) if need be write the letter yourself and have the doctors sign it. Confirm that they have the letter and then start calling them every week. Ask to speak to whoever approves/denies request. Basically start hounding them and do not give up because that is what they want you to do.


(davyboy) #7

Medicare is now allowing Dexcom g5 specifically, because it won the okay from FDA to act as a glucose meter, the first CGM ever to be that accurate. So before May 28, get hold of Liberty Medical CGM team and request it. Be ready with the following: a blood test showing your glucose level, your A1C, and some measurement that proves you are type 1. Or just call Liberty and have them get the it all roling, but move quickly, as they will stop supply the Dexcom system as of May 28.

Also, have 60 days of glucose meter readings, at least 4 per day, and have your Endo give you six months of records on you.

If there is time before Liberty Medical pulls the plug on processing apps for the Dexcom g5, just let them do all the work. But if there isn’t enough time, tell them you’ll help get info together to get it done on time.