DexCom & Pediatric Approval

Hi All, I’m new the T1D community and this is my very 1st post on tudiabetes, so appreciate in advance any advice you have. We’ve just received a denial from our insurance company for my T1D 3 year old to go on the DexCom. We were denied due to pediatric use, but have been hearing that if we are willing to submit our request for the Medtronic we’d have better luck. Appreciate any thoughts out there on DexCom versus Medtronic, should we be reconsidering our decision? And any thoughts on successful appeals for the DexCom?

I have not usd the Dex, but currently use the MM - and have had great luck with it. Some people don’t have great luck on the MM. I suggest you go to the Children with Diabetes forum and post there too - there are a lot of D moms and dads who have gone through this exactly. Ttry this:

Honestly the needle alone is to big for a 3 yr old to take… Dexcom is one thing but the minimed is huge… and the sensor NEEDS to be taped down… i myself wouldnt make him/her go threw the CGM till like 5 and it will be better by then also…

The dexcom is not certified for children at all, hence the ins co will deny it. The revel MM pump CGM combo is and is nearly as accurate. The insertion is a bit more of a challenge with the MM.

I would suggest at least trying to appeal. MDs are free to prescribe medical devices for groups (such as children) for whom the FDA has not yet approved those devices specifically as in Dexcom’s case for kids. If your MD writes a letter to the insurance company as to why he is selecting that monitor as opposed to the Minimed, the company may agree. Perhaps you could find evidence (as on this site) as to why the Dexcom is a better choice for your child to support your appeal. If not, by all means try for the Minimed. With luck, Dexcom should be receiving approval before too long and you could switch then if Minimed is not suitable. I’m a school nurse who also happens to have diabetes and would be interested in hearing your experiences in trying to get the monitor covered.

I agree about trying to appeal. Alot of insurance companies turn them down automatically for adults also - I had to appeal to get one and I won the appeal. Like Jennifer said, check out CWD. Alot of parents there have them for their kids and they can give you some good ideas for your appeal.