Here’s an excerpt from the “Medical Policy” from my insurer (Providence). Warning: they use this policy to deny coverage for CGM. Many other private insurers have similar policies. If there’s a way to review the “Medical Policy” of the insurer before you sign up, maybe you can find coverage.
"Long-term use of CGM is an expensive technology that may have clinical utility when there is poor control and all other interventions have failed. It is not covered for convenience. CGM may be approved in the following cases when prescribed by a diabetic specialist in a Type One diabetic when:
• Unexplained large fluctuations in daily pre-prandial glucose values
• Unexplained frequent hypoglycemic attacks
• Episodes of Ketoacidosis or hospitalization for glucose out of control
• Pregnancy with insulin dependent diabetes
• An insulin pump regimen, where qid glucose monitoring has failed and lack of control is documented. A pump and CGM device are not approved at the same time.
OHP: CGM may be approved in the following cases when prescribed by a diabetic specialist in a Type One diabetic when:
A. Insulin pump management is being considered, initiated, or utilized and only when the patient has at least one of the following:
• HbA 1c levels greater than 8.0% (despite compliance with treatment), or
• A history of recurrent hypoglycemia
CGM is not covered for;
- Patients with compliance issues
- Diabetics not on insulin or diabetics taking only basal or bid insulin