Hi All.
I’m new to the forum.
I was just wondering if anybody else is having issues with Anthem BCBS denying their dexcom and what or who else should i go to, to get it approved. I’ve been calling and calling and emailing, and sending messages on facebook. This is so frustrating. Or any tips would be kindly appreciated. 
Thank you - Amy.
It depends what your insurance policy says.
And if your doctors script is still valid and how long it’s been since you last saw your doctor.
Some insurers have rules about what type you are and weather or not you take insulin.
And then there are delays in getting products shipped sometimes.
It should all be spelled out specifically in your policy though
I know there are many people on blue cross blue shield who use dexcom.
I’ve never had a problem, and I’ve been using Dexcom for years with Anthem BCBS.
However when I moved to a new state a few years ago, I was denied. The reasoning was that my diabetes was “well controlled.” I was floored and called customer service. I think the doctor may have had to send them something, but the issue was resolved thankfully.
Do you have an employer plan? If so, someone in HR/Benefits dept may be able to help.
You may need to get dexcom from in network DME suppliers of your plan, or Pharmacy, and meet certain insurance criteria.
Remember Dexcom is a prescription benefit. If you have a separate prescription benefit you should call them. I have Ingeno and which is a separate division of Anthem.
It depends on insurance plan. Mine insurance switched last year, but i think some insurance still does DME only.
If you have a Rx formulary, it should be easy to verify.
I’m currently not employed.
Im not sure which i have, i believe it’s Ingeno as well.
They’re reviewing the appeal. I was told id have an answer by April 11th.
I saw my doctor last month.
its probably gonna take playing phone tag for a while im guessing. =/
Amy, I happened to think you are in Canada, my response was based on the US. So it is best to ignore what i had ot say. I do not know anything about Canadian pharmacy benefits.
Oh im not canadian. I’m in Kentucky lol. 
Cantucky
Many insurance companies are different , I’m with Medicare still have to prove I have a physician and am on insulin. This gets updated every six months… at one point in my adventure, I decided too get tighter control on my Glucose levels as I only bolus dose. After some diligent searching for a pump that would not Waste my insulin, as I only bolus dose less then 15 units a day. I found a pump , but Medicare would not approve it as they considered my diabetes not bad enough.
Was there something specific, such as C-peptide test that caused denial?
Yes the C-peptide was the issue
You should be able to get it pretty easily as a type 1. But some specific insurance plans have certain requirements.But what can happen is it is turned down and then your doctor has to send in an appeal saying why you need it. And a lot of the time your doctor can get it approved if they are familiar with what to submit. An endo probably is better than a pcp in knowing the ins and outs of how to get it approved.
But BCBS has several options in plans. Besides regular plans, BCBS has HMO plans and I believe advantage plans too and they can really limit your options in what you can get through them. So it could depend on your coverage.
@John70 , Medicare has very specific rules about the c-peptide value to put you on a pump. Your endo & in office pump specialist should know and be able to explain them to you. In the absence of endo’s support, some endo’s have not taken the time or effort to understand insurance coverage, especially Medicare. Get your lab values for c-peptide, diabetic co-morbidities, and certificate of medical necessity with rationale. Appeal the decision.
Medicare does not require blood tests if you are already on a pump before you start Medicare. So it’s something you might want to consider before you transition to Medicare if you intend to get a pump
@Timothy , when I crossed over onto Medicare, in order to have Medicare pay for pump supplies, I had to re-qualify for a pump even though the pump was already paid for by pre-Medicare insurance.
My experience is if you want Medicare to pay, you must play by their guidelines.
@Jay6 I did not have to re qualify for anything when I went on Medicare. I had gotten an Omnipod and Dexcom originally through BC/BS. When I went on Medicare the plan automatically converted to a gap type insurance. I contacted Dexcom who contacted ADS and ADS handled everything for me regarding my Dexcom switching over to Medicare. I contacted Omnipod as on their website they said Medicare covered it and they would make sure all the paperwork was fine so you wouldn’t have any issues. I didn’t have to do anything other than calling my doctor and OptumRX with the new insurance numbers.
I already had very good control, so that had nothing to do with it. But years ago I had the positive antibody test and a C-peptide test which showed I didn’t make insulin in my records.