I’ve had diabetes my entire 21yrs of life lol. Ive been pumping for about half of those yrs. My diabetes is so out of control still. The only experience I’ve had with CGM’s was once when I had to wear one for 3days for my Dr. I really want to have one…full time, and I know it will help so much with control of my diabetes. But my doctor said that they’re not covered by insurance… I see that a lot of ppl on here have them… any advice?
Who is your insurance provider? They are covered by many insurance plans, although the amount of coverage can vary widely. Have you spoken to your insurance company yourself to verify what your doctor told you? I have had mine covered at 50% by Aetna here in California, and to a larger degree by Blue Shield (PPO plans in both cases).
More and more insurers are covering them. Check with your insurance company, not your doctor. OR check with the CGM maker - they’ll do all the work for you because they’ll get the money. If it’s not covered under your plan you’re looking at shelling out $600 up front and another $300 to $600 for the year.
Ditto what oneless said. I’m also in California with Anthem Blue Cross - it covers 80% BUT only if the CGM is deemed ‘medically necessary.’ In Anthem-Blue-Cross speak that means you get more than a couple of lows per month. Being consistently high doesn’t qualify. I discovered this when my CGM went from not covered to covered last year. I had to show Blue Cross that it was ‘medically necessary’ under their terms. Problem was that because I’d been using the CGM I didn’t have a lot of lows so they didn’t want to cover it. In short, because it was working, I couldn’t get coverage!! (That’s like saying 'you don’t need to fill up with gas, your car is running just fine!") I had to wait until I suffered three lows within two weeks to convince them to cover it.
I have better control when I use it, but it’s not a magic bullet. You still have to pay attention to what’s going on.
Good luck,
Terry
Agreed. I pay more attention to my blood glucose with the sensor than without, but I am considerably less anxious about my overall condition when I can see my trends in real-time.
Have your Endo work with you so that your insurance covers a CGM. CGM’s are proven to help and better control diabetes. If an insurance does not want to cover, lets start a blog and do bad publicity. I am from Europe where more things are covered than not, now leave in the US and find this to be outrageous that for profit only American insurances decide on what they want and not cover. To me this is domestic terrosism.
I would also call whichever CGM company you are going to go with. Get the insurance billing code and call your insurance company. Don’t take their first no (they always say no) as final. I had to have a guy at Minimed call my insurance company 12 times (12 different people too) to get them covered. Most of the people that you would talk to don’t even know what a CGM system is, that’s why you need the billing code. They guy at Minimed even told me that after giving my insurance company the billing code he was told once that the sensors where “an experimental anti-depressant”. HUH??? Yeah, lots of low hanging fruit at some of those companies. Get your endo and the CGM company to tag team them.
I use the Minimed CGMS but I do not have coverage. I just pay out of pocket and strain financially other places.
Me, too. I stretch the sensors out to at least 6 days, and sometimes will not use them for a little while. Is it worth it? In my case, yes, even though it can be annoying at times (lost sensor/weak signal alarms in the middle of the night because I rolled over on the sensor and the signal can’t get through my body). But, the trend analysis is very helpful and the sensor causes me to pay more attention to my numbers – I see how long I may be high, so I work harder to bring myself back down.
I would pay 100% out of pocket if I had to. Once you get used to seeing the real-time trends, you feel naked without it.