How did you get approved for a CGM? I am wanting a CGM as soon as I start basal insulin (on bolus only right now) I am even willing to pay out of pocket if my insurance will not approve. Anyone know the cost of it out of pocket and then for the monthly supplies?
Thanks,
Jenn
I don’t recall the specifics, but I called my insurance, first, to see if they would cover it and they said no problem. I just had to get a prescription from my endo and fill out the necessary paperwork. My endo took a look at my BG logs and told me, based on the number of hypos I was having, it shouldn’t be a problem. I downloaded and filled out the paperwork from the Dexcom site, handed it over to my endo, and he took it from there. I’m not sure what he did, I had the impression from speaking with my insurance company that it was pretty much a done deal if I could get the prescription. My endo told me that he wrote somethng about being concerned about my hypos, which he was, to make sure that the insurance would give the green light.
Whatever the process was, from the time I handed over the paperwork to the time I had the Dexcom in hand was less than a month, back in June. I just got a letter from my insurance company that I’ve been approved again for this year based on medical necessity, whatever that means for them.
I vaguely recall a Dexcom rep telling me it was about $2500 cash cost out of pocket… The gentleman below tells a similar story to what I was told as far as approval goes…seems insurance companies have a morbid minimum threshold of about 5 hypo episodes at 50 or below before they’ll approve… Strange given the relative cost of my 10-20 strips per day…I would have thought that demonstrated commitment and excellent control without it would warrant approval since that would indicate to me anyway that it would only get better with the CGM…therefore lessening the threat of far more expensive complications… Good luck…
As a type 1 adult (even with LADA) you should have no trouble getting insurance approval for one… you need to talk to your endo and get the process started there since you will need a prescription before you can get one.
My insurance paid about $1000 for my dexcom system the year I got my last pump (I had met the deductible), and I pay about $300 for a box of 4 sensors since I haven’t met my $2500 deductible, which typically lasts me two months since I usually wear each one for at least two week long sessions (sometimes they make it through 3).
As a comparison, I spend about $125 on pump supplies a month, so wearing the CGM is only slightly more than that.
BTW, I should add that I also had no trouble getting it approved by my insurance (Humana), all they needed was copies of my logs.
Some insurance companies are easier to get approval than others. My insurance turned me down and I had to file an appeal, but I won the appeal.
Dexcom often has deals that you can one for about $1,000 cash. It is my understanding that their cash price on sensors is about $325. American Diabetes Wholesale carries the Dexcom & sensors and their current price is $956.80 for the Dexcom and $349.99 for the sensors. That is the price without their member discounts.
Having a 3 month log is the best way to go. Your highs from late will be good ammo as well. They will question if you have lows too and once you start on insulin that can be a concern. That might be the sales pitch you need to get it. Also, try to get your doctor behind you. That can be helpful for writing letters and what not. Good luck!
And is this for a one month supply of sensors?
Thanks for the reply FHS, I will be calling my insurance company and asking my endo about one next week.
It is for a box of 4. That might last 2 months if you are able to get 2 weeks out of each sensor. Just know that not everyone can do that - I can’t, but I am in the minority.
Bear in mind, one sensor is FDA approved for one week, but lasts up to 4 weeks. The one month supply thus is a box of 4 sensors.
wow thats good to know…is it still accurate after the first week?? well obviously or ppl wouldnt do it but just wonderin how some ppl get more wear out of em.
Gosh, I am just not in a hurry for a pump or a CGM. Not that I would have any luck getting them. Perhaps you could get a loaner from your endo for a week or two. So far, I’m lookin pretty good, I don’t have hypos, not a lot of unexpected wild stuff goin on. If I’m dealin with this insulin thing for coming decades, maybe I don’t want to scar up my body if I don’t have to.
If I had to spend that kind of money, I’ve kinda had my eyes on a dumbell set. Oh, wait, maybe dumbells is the answer to Karen’s trivia question. Hold on, I gotta go.
Thanks! Will be filling out the forms from the website 
Thanks Sarah!
Wow…so I may need to pass out a few times to get approved…nice!
lol yeah I know it’s just that I have young children and my husband travels all over the country on business leaving me here for days at a time and all of my family is 9 hours away so I would just feel much more secure and confident having a CGM.
Do they really cause bad scarring??
No, idea on how to ger more wear. Its one of those YDMV things. For me (and from what Ive heard) port first week trends are more accurate than the first week itself. I try to keep it to about 21 days or so.
as for tissue issues, I don’t have red dots post removal nor toughened tissue as far as I can tell. Honestly, I think I would give up ther pump before the dexcom if it came to that.
I am looking into getting the Dexcom, too. I contacted Dexcom directly and they have been helping me with the process. I am currently waiting to hear back on my insurance’s decision (BCBS).
However, I am wearing a CGMS system right now. It is a 3 day blind study. I wear the sensor, but not a transmitter and log everything all day long. At the end of the 3 days I see my endo to review the results.
I’m hoping it’s a good dry run to see how I like wearing the sensor. Also, I just went on the OmniPod pump, so I want to see what that’s doing. I am sure the information is not as good as a real-time CGM. But it’s what I’ve got for now.
I am trying the MiniMed iPro CGMS (http://www.minimed.com/professionals/cgms/index.html). Dexcom has one too, but my endo doesn’t offer it. You may want to see if that’s an option for you.
less if any scarring than a pump because it’s a tiny sensor going into your skin.
As far as accuracy usually at the beginning of a sensor use it’s less accurate but improves over time and for me the second week tends to be more accurate than the first week.
I haven’t had more than 2 weeks since the adhesive wears off or the sensor or extra adhesives start irriating my skin
Check out the dexcom group on this site too, which has discussion about these issues.