Following up on a recent post about the increase in cost for Dexcom sensors after Dexcom made a deal with Blue Cross for coverage, I called up Dexcom to check on the prices and coverage.
Sure enough, Dexcom and Blue Cross made a deal and the price went up. But that’s not what gets weird.
Turns out my Medical Necessity letter has expired, so Dexcom needs a new one from the doctor and needs to get preauthorization from Blue Cross before BC will pay it’s share. They also need 30-60 days of BG readings. Okay, Fine, No problem.
Get a call from the Dexcom Rep asking me if I have more readings that show more “Lows.” BC apparently has some threshold of lows it needs to see before it deems the CGM ‘medically necessary.’
So the upshot is that I may not have enough lows to qualify.
In other words, because the CGM is working and helping me prevent lows, it’s obviously not medically necessary. Because it’s working, I don’t need it? So are they next going to deny coverage for my insulin because it’s working to keep my blood sugar down?