Is this possible/advisable? I had a meeting with a dietician/CDE yesterday and she really wanted me to look into a CGM because I’ve been having some trouble with lows lately. I can’t imagine insurance covering this, as my A1C is in the normal range. My lowest was 34, but more often in the 50s. I do have symptoms, sometimes before I’m even actually low (in the 60s and 70s). My dad does have one he’s not currently using, and she suggested that I borrow his.
Are you on insulin? There is zero reason insurance won’t cover a CGM, simply because your A1c is “normal”. My wife’s A1c is 5 and she has an CGM thru Medicare. Mine is around 5.8 to 6 (varies from test to test) and I also have one. If you aren’t on insulin, that would be a different story. talk to your doctor if interested, as u need an Rx.
Yes. I’m on Humalog and NPH. In the past it’s been difficult to get them to cover things and my A1C (5.0-5.4) is typically the reason they cite. I might be able to play the pregnancy card, but I’m diagnosed T2 so I don’t know if that will make a difference.
The history of low blood glucose incidents is usually the best approach to getting CGM covered by insurance. When I first got approved for a CGM, it was when my A1c was 4.9, but I had 3-4 sub-50 BGs a month.
You need a different endo. Our endo has gotten coverage for things that normally aren’t covered (for my wife, due to her diabetes “numbers”). If you don’t have an endo that is a super-advocate for their patients, then you will likely have a variety of coverage issues.
I really like my current Endo and I don’t really want to switch in the middle of my pregnancy. They do try to help out with insurance, and give me samples and stuff. I think the fact that my diagnosis was atypical (I was diagnosed with an A1C of 5.8 and fastings in the 80s just off of high post-prandial numbers and a history of GD) combined with being diet-controlled normally makes it harder to get things covered. They have been pretty good about everything since I got pregnant though, so maybe there is hope. I will talk to my Endo more about it at my next appointment next month.
Should be possible - I was even still diagnosed as Type 2 when I got my CGM.
@Tomato, my T2 friends have CGMs, but the process seems to be harder than for a T1. Many (most) insurances will deny outright for a T2 unless the T2 is Hypo- unaware. Hypo-unaware, a history of hypos, and/or hospitalization for hypos all help when doing the medical necessity dance with insurance. The fact that you are pregnant should also help. If you do not have a history of hypos, a Freestyle Libre is much easier to obtain and squarely aimed at the T2 community. The only disadvantage to the Libre system is not having alarms with out having to do an unofficial system hack with something like BluCon.
I would suggest that if you pursue a CGM that you be prepared for possible denials and appeals. Persistence does pay off when trying to get DME, and a CGM is very helpful.
My old Doc owned one and used to borrow it out to different patients. Yes, I think you should take it on a spin around the block.