Has anyone had any luck with dexcom working with their insurance company for coverage? I got a hold of Dexcom and sent them my request for them to call me. They called today and the representative sent me a form to fill out with my information. They hopefully can convince my insurance company to cover my sensors. Right now we pay out right and put it on our income tax at the end of the year. Once you start using a cgm it is very hard to do without. If I didn’t have hypoglycemia unawareness it wouldn’t be so bad as I could use less sensors.
First thing I had to do was appeal my insurance company’s denial of coverage. There was a lot of paperwork involved in the appeal process, as well as phone calls to cajole the insurance company to get somebody who understood what they were reading read the documentation I sent them. After I won the appeal, my insurance did not consider Dexcom to be “in network” for buying CGM supplies. They contracted with Edgepark as the only company I could buy CGM from (if I wanted insurance to cover most of the cost, which I did).
If you have to appeal to get coverage, there are other posts on this site with good info. My #1 advice is request a copy of the “medical policy” from your insurance. That policy spells out exactly what you and your doctor have to prove in order to get coverage.
Tell your Doc to claim ‘medical necessity.’ Depends on how you define ‘successful’ coverage. Dexcom’s defined under non-durable medical supplies, so it is always going to be less covered than other things. But, every little bit helps. In the state of Minnesota, pumps and Dexcom (I believe) are covered if you are low income. So, yes, sometimes things can be covered at 100%. That is the only situation, though, that I have encountered 100% coverage and thats relatively new for Dex. My personal policy covered durable medical equipment, like the pump and Dexcom receiver, but I pay a bunch for replacement sensors and pump tubing and stuff that I throw away.
I am in Windsor Ontario, Canada. We have a 2400$ /year grant which barely covers the pump supplies. Cgm sensors aren’t covered yet. If I get turned down I will see my endocrinologist in February and get him to write me a letter to claim it as a medical necessity. I am hopeful that things will turn out in my favour.