Being forced to stop using my Dexcom :(

I :heart:my Dexcom , today I unfortunately ended up in tears because I was denied coverage by my new employment insurance for a device that was already paid for by Great West Life all #manulife had to do was cover my sensor and transmitter. Something I’ve been using for almost a year and now I’m told it’s not a necessity for me because it’s an upgraded pump but my plan covers both CGM and Pump according to manulife. I will appeal but Great West was awesome to deal with, I’ve been with Manulife for 2 weeks now and I’ve already had so many issues. Sent in certificate of necessity by endo and big data for three months and denied because their tech decided… . I could spend the 300/month but it’s too much $$$ at the moment. It’s like the insurance company ripped my eyes out and said “you don’t need these anymore” so frustrated, sad and depressed…

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I’m so sorry you’re having such a difficult time and hope your appeal is successful.

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If you haven’t already done so, contact Dexcom to ask for their help.

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@Chris69 I am appalled! The Dexcom has been SUCH a life saver for us: it comes right after insulin.

Please investigate carefully exactly what the appeal process is at your insurance company. so that ou can understand exactly what to do for each appeal stage, and be 100% ready with documents. Our insurance company also has a way for your endo to talk directly to a medical professional about the case - possibly it is the same to you?

Also - you may want to involve your work place HR, explain how important it is to you, and have them intervene in the discussion if they are willing to do so. I know many cases where that has worked for friends of mine.

I CANNOT imagine being without our Dexcom. I really hope you can find a way. This is shameful and senseless. I will remember the name of your insurance (Manulife) and make sure I never contract with them when setting up workplace insurance. But - I am pretty sure they will end up caving in. It is standard practice for some insurances to deny automatically and wait for the customers to submit appeals. Be strong!

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Using a CGM is expensive when you have to pay on your own, but if you can’t get coverage (Pacific Blue Cross denied me coverage twice, will try again in a few months), you definitely don’t need to spend $300/week. I stretch sensors out to two to four weeks (I’d wear them for four months if they would last that long!), so my cost of using the CGM sensors is about $28/week on average. Of course, the transmitter and receiver add a lot to those costs, but I use each of those until the batteries die, and they typically last twice as long as their warranty period (a year for the transmitter and so far two years and still going for the receiver). Stretching supplies makes CGM affordable when I otherwise would not be able to afford it (if I followed their suggested use times).

I hope you are able to get coverage for your CGM supplies soon.

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I"m in Canada, where things are a a little different, but I have found Manulife to be a bit difficult sometimes. I think it’s a travesty that they will not cover such an important device. I have to jump through some hoops to get a pump (the government pays for the pump and 75% of the supplies if you qualify,) but they aren’t flaming hoops. I hope you can resolve this quidkly and satisfactorily. In the meantime, you have to finger-stick twice a day anyway, so doing it four to six times a day will only be a bit of a PITA. Best wishes.

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I’m pretty sure the OP is Canadian. At least Manulife and Great West are both Canadian insurance companies. I’m currently with Pacific Blue Cross who, until recently, has said flat-out no to CGMs for everyone, despite letters and appeals. Now they are apparently re-evaluating whether to cover CGMs, so I’m hopeful that they may be covered in future.

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I lost my coverage when I went on Medicare. So I pay out of pocket. I also stretch out the sensors to last as long as possible. If you get on the automatic delivery program, they will reduce the cost of transmitters. It is still expensive but it helps.

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I can’t remember whether you are on Medtronic or Dexcom. If you are on Dexcom, I know of several people who have been sent sensors at no charge by Dexcom in the last two weeks. Dexcom is indicating that they will take care of the Medicare coverage as regulations are issued.

If the OP is in Canada, then Dexcom sadly doesn’t offer any kind of discount on sensors, transmitters, or receivers like the US does. Animas sometimes offers deals, but only in conjunction with getting a new pump (and based on recent news about them, they are not doing so well).

It’s a shame we can’t all get equal coverage.

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Thanks Laddie. I will call dexcom and see if they can help or tell me what I can do.

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Thanks everyone for the support! So I got the letter today and it states that its not a required piece of equipment because I havent had significant hypos in the last 3 months ( which comes from the BG data had to send in) Manulife is just annoying and the customer service sucks.

While you are doing the appeal process, check with Dexcom to see if your health plan covers Dexcom in other regions. My plan in the Pacific Northwest does not (will not) cover CGM. After a lawsuit in California, they wre told they had to cover it - in California. Dexcom told me that I would have to pay out of pocket, but I could pay what my health plan pays - which is 50% of the cost to consumers (don’t get me started on why healthplans or should I call them ill-healthplans get to pay half of what we would). It does make it easier for me to afford my CGM. I have been using a Dexcom for about 8-9 years now and it is part of the reason my labs come back consistency in the non-D range. BTW I know for a fact that I have not been cured…

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It is always crazy hard to get CGM’s paid for. In the Pacific Northwest things are slowly changing, however. The health plan with that starts with a K, has finally started allowing kids over 13 to have insurance for a CGM, when previously, you had to be younger than 12. Hopefully, things keep changing in this regard. The CGM is undoubtedly, the best technology available for those that choose to use it. Unfortunately that study that showed only those over 25 consistently use it, is a frustrating reminder that technology isn’t helpful if it isn’t used. Fortunately, my 14 year old sees the value and chooses to use the technology.

Have you reached out to a local or state diabetes Foundation in your area? I know ours has supplies on hand to help. Not to say they could hold you over on a long or permanent basis, but perhaps they could help until you possibly get your insurance to reconsider? They might also could help you with insider discounts perhaps? Or help advocate with your insurance? Just some thoughts.

MY insurance tried that approach once – my endo went ballistic: HOW can you show that you have significant hypos when you’re using a device designed to help you prevent those incidents in the first place!! It’s like telling someone on a ventilator that they’re obviously breathing, so they don’t need that equipment anymore! We won that appeal…

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Sorry to here of your problems with the insurance, as for medicare: Combination Insulin pump and Continuous Glucose Monitoring (CGM): Insulin pumps
with integrated feautres such as CGM are also billed using HCPCS code E0784. Although
the integrated CGM features and related supplies are not covered, coverage decisions for
the device should be made based on its primary use. See Guideline 5 [Continuous Glucose
Monitoring (CGM)] above for coverage guideline of CGM.
 Disposable drug delivery systems (e.g., OmniPod® Insulin Management System)
Disposable drug delivery systems, including elastomeric infusion pumps (A4305, A4306,
A9274) are non-covered devices because they do not meet the Medicare definition of
durable medical equipment. Drugs and supplies used with disposable drug delivery systems
are also non-covered items. See the DME MAC LCA for External Infusion Pumps - Policy
Article (A52507). (Accessed November 30, 2016)

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I really do hope your appeal is successful. Insurance companies only make profits when they don’t pay claims.

That being said, they would have to rip my Dexcom out of my cold, dead hands. For two of the eleven years I’ve been continuously using a Dexcom I was uninsured. It proved so valuable a piece of equipment that my wife and I did without lots of things in our lives in order to keep paying for it. Not having it is not an option.

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I’m so sorry to hear this. Fight, fight, fight!!!