To get insurance to cover a CGM do you have to have hypoglycemia unawareness?
No....Dexcom has on their website a CMN to show you the various reasons a person might need a CGM....http://www.dexcom.com/sites/dexcom.com/files/getting-started/docs/c...
Hope that helps!
When I got mine, It really helped that my prescription read, hypoglycemic unawareness and I also wrote down 30 days of 4 blood sugars per day.. and I made sure I put on that 3 sugars in the low 50's and 3 sugars above 330.. I definitely have had sugars in the 50's and not recognizing them, and I definitely have had sugars in the 330.. I did this all by hand and they never even asked for my meter, if they did, I would have said I lost it.. not sure of the "official" insurance rules now, but I think it would be easy to do the blood sugars and it would be easy to get the hypoglycemic unawareness.. this is my opinion
It definitely makes a stronger case if that us the case but not necessarily so. With Medicare, you need to go through an appeal process AND have to have a statement from your endocrinologist on the medical necessity of the device. If you are not covered by Medicare, your plan may cover it and you should call them to find out what the story is. Attached is some national data that may be of some assistance.[691-Singh2013HypoglycemiaSlideDeck.pptx|attachment](upload://33AGPegySCjiLfzlmI8hEbIouqi.pptx) (241 KB)
Like JM, I had to submit some blood sugar readings. I think I had to list when I was below 50 or 55 for a certain period of time. I don't know if that was a requirement of my insurance company, Dexcom or my CDE who submitted my application. My endo was very thorough in marking all my problems. My CDE was astonished when my insurance approved me in 2 hours. She said it was the fastest she had ever seen.
I'm sure that my hypo-unawareness helped get me approved. I think the insurance companies didn't understand the value of CGM five years ago when I got my first system 7.
It all depends on what your insurance rules are. For me it was as simple as contacting Dexcom, giving insurance and endos contact information. They did the rest. My endo office filled in the MD forms, sent prescription etc. Dexcon dealt with insurance clearance.
I did not need to provide any BG records etc. Don't know what all my endo practice checked off on the forms, but I do use a large Diabetes Center with CDEs,and a pump team in addition to a group of MD's.
Most of the paperwork gets done by the CDEs/NPs rather than by the docs.
I have the Dawn Phenomenon. I also didn't have to submit any logs. Really depends on the insurance.
My Doc just listed me as "not in control" in his log (sent to the Insurance company). Not exactly true, but it helped. Needless to say, I'm in more control now that I've been in a long long time.
Dexcom said I needed 4 readings under 50 so my insurance would say I needed it. Unfortunately most of my readings were in the 300-500 range. My doctor wrote it was a medical necessity and I got it 100% covered. Seems to me extremely high numbers should count. Since getting the Dexcom I am mostly under 130 so it helped my highs!
Thank you all for the information!! I was having a lot of trouble over the past month getting the CGM approved by insurance because my endo filled out the info and didn't really help highlight my need for a CGM.
You can always get a copy of the MD paperwork, check what you need to emphasize your need then have doc sign and you submit to dexcom. I think it's is a box check kind of a form so will be easy for you to do it yourself.
Bailey - dexcom wants you to have the device call them and ask them what you should do about the dr. Not filling out the info in your favor. My endo asked the rep that calls on her what the insurance needs her to say so I would not have an issue getting it payed for. Good luck. Don’t give up because it will change your life
in Canada and with 3 months worth of blood work and 3 A1c's and prescription and they would not cover it. going to try again next year when I have to get a new receiver. wonder if we will need a receiver by then. hmmmm