Paying for CGM


(clcapece) #1

Hi: I’m struggling with getting the Dexcom device covered by my insurance company and my doc thinks there might be a lower out of pocket cost for the Libre. I really want the Dexcom because it seems better, easier, etc. But i’m concerned about the cost. Anyone have any experience with this? How did you manage it?

Also, any insight on your experience with Dexcom vs Libre would be awesome. Thanks!

Carol


(Dennis J. Dacey, PwD) #2

Hi Carol @clcapece , I can definitely appreciate where you are at having wanted / needed a “non-passive” CGM but found the monthly cost to exceed my monthly Social Security - I put food and shelter on a priority over the monitor; I needed the non-passive with alarms because I had passed out a couple of times due to low BG. Thankfully CMS/Medicare was ordered to now provide CGM when a medical doctor prescribes it as “medical necessity”.
I understand the Libre is very good and the cost is less - will this be covered by your insurance? You would need to sacrifice the audible alarms which just in the past month have awakened me.


(jjmnav) #3

I like the active monitoring that Dexcom offers, alerting me WHEN going High or Low while Sleeping OR Awake and too busy to check the receiver every hour.
If you are stuck paying out of pocket (I am), I highly recommend dealing directly with Dexcom for (IMO) best available prices. Their Auto Ship program offers discounted prices on sensors AND free transmitter after every 9 shipments.


(ksannie) #4

My insurance used to cover Dexcoms when a patient had hypoglycemic unawareness. It took me awhile to get this information from the insurance company. But when I did, the appeal for coverage worked. I lost the sensation of low BG’s after about 15 years. I can now sometimes sense them, if I find I am confused while trying to do 2 things at once, but not always. Also, I do not wake up from low sugars unless my Dexcom wakens me. So it is a life-saving measure. Insurance may also cover it if you have high HbA1C’s. It is cost effective to have a sensor system warn you when you start to go high, so you can correct it. A lower HbA1C costs less because health problems and diabetes complications are lessened.


(Lori) #5

Dennis can you share where to find that Medicare was ordered to provide CGM when a doctor prescribes it as medically necessary? I’m fighting for Texas Medicaid to cover a CGM for my T1 15 yr old son. All amo I have ready for an appeal of a denial will be great!


(J) #6

Hi Jimnav,
I can only imagine how difficult hypoglycemic unawareness can be. That is part of my reason for using a cgm and pump. Why do some people have it right away and others never have it? I figure I will probably have it sometime soon since I’ve had T1D for so long. I have single-sided hearing loss, so if I sleep on my hearing ear side I miss the alarms. The vibration mode doesn’t wake me up.
Any suggestions on this problem?


(Dennis J. Dacey, PwD) #7

Lori @lvanroo van,
Here is the link to the initial CMS ruling: https://www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/Downloads/CMS1682R.pdf
I don’t have any idea how or if it will work for your son under Texas Medicaid. Medicaid and Medicare, although they sound similar, are not the same animal. Another avenue you could peruse is through the CGM marketing staff and listen to their suggestions for getting coverage.
It takes time, for me, 18 months after the attached CMS ruling.


(BeccaGae) #8

Even though Medicare and Medicaid sound alike they are two separate beasts…
Medicare is for seniors 65+ and disabled individuals (comes from Social security/Centre for Medicare/Medicaid) and Medicaid is a joint federal/state programme so that is why it differs between states (states get to pick and choose what they will cover who they will cover, and how much they will cover).
MOST states flat out REFUSE to cover CGM’s for adults (I know Oregon DOES cover Dexcom and MiniMed’s CGM for adult), and some cover for children. Some cover pumps for adults and most cover for children (Oregon covers for both) (I don’t have medicaid but I know people who DO have it that ARE adults that do not have kids, that are on pumps and Dexcom and are not disabled).