has anyone had trouble getting insurance to cover their cgm?
Actually I was pleasantly surprised that I did not have a bit of trouble getting insurance approval and it was approved quickly. I have a Dexcom and the Dexcom folks work with the insurance company to secure approval. I was wary of the out of pocket cost to me before I wanted to commit so I called Dexcom to check what my BC/BS coverage would pay. My benefits plan says 80% for durable medical equipment but they actually paid 100%. No out of pocket cost to me.
Dexcom has a questionnaire they ask you to fill out to help them make an argument for coverage with the insurance company so you have the opportunity to write a convincing explanation of why you need a cgm. My endo also had to write a letter to support.
When I first went on a pump 5 yrs ago my insurance did not cover it. It was considered as experimental by BC/BS. I was approved for it this year when my old pump was replaced. I got the Revel 723 with CGM. Since I met my annual out of pocket it was covered 100%. Medtronic also sent me insets, IV3000 and reservoirs, enough for three months. I have been using it now for three months and yesterday got another shipment of supplies. I am not sure I like the device because it requires a lot more attention to my treatment. I'll try it for another three months. Of course, on Jan 1st the coverage renews and I will have to pay 20% for supplies in March. With CGM I am now testing 8 - 10 times a day. BC/BS covers my strips at 100%. In reading a few different posts on other sites I think CGM is being more accepted by insurance companies. Many health insurers require a few months of data from your CDE or doctor before it gets approval. I suggest you hold onto three months worth of data to prove the need for CGM. They probably may want to see A1C's too. Hope this helps.
I have the MM Revel, and like smileandnod, I contacted Medtronic directly basically for the same reasons wanted to see what MY cost would be before I went any further and how soon I could get approved. I thought I was going to have to wait a little bit longer on one of the criteria, but surprisingly enough I contacted Medtronic via email on a Sunday night, the Rep called Mon, but it was actually Tues before I had a chance to return her call, she forwarded my info onto their insurance rep, he contacted my endo office and BC/BS and by Wed or Thurs was calling me back saying I'd been approved for both my pump and CGM and how soon did I want it. The key to is just meeting the criteria they outline. I have very unexplainable hypo's that despite MDI and correct carb counting just happen and Im hypo unaware anymore so it was very easy to get my insurance to approve my CGM.
If your interested contact whoever you are wanting to go with directly, let them deal with your insurance and dr's offices. They know all the ins and outs, its what they get paid to do.
I think it also depends on what type you are too. I think since type 1's are completely insulin dependent the process might be a bit easier. I think sometimes insurance companies make type 2's jump through hoops.
I'm also type I and have become somewhat hypo unaware also. This was one of the questions on the questionnaire for the Dexcom so is probably one of the reasons I got approval quickly as well.
I agree it is now not really considered experimental as it was and a lot of the criteria has lessened. Definately a good idea to have at the VERY minimum a month of testing..of at the VERY minimum 4 times a day, but I'd recommend at least 8 to 10 times. Once again its really all dependent on your insurance's requirements, a lot of times with some digging around on line you can find the criteria for your particular insurance or if you call they may be able to provide that to you. But when you make up your mind to persue it, contact the company you go with directly, let them work out all the issues with the insurance company. They are great at what they do.