So Ive been looking at getting a CCGM for a long time. My old insurance flat out told me no. Ok, fine. I got a new job with slightly better health insurance and I asked my doc about it.
They said of the 5 people who have gotten one, none of them wear it except for 3-4 days a month because all it does is beep at them even if they widen the parameters…
it honestly sounds like they just dont want to help me fight the insurance in order to get one.
Any opinions?
When I applied for my DexCom 7+ all I asked of my doctor was to sign the paperwork. DexCom handled the communication with the insurance company. If my doctor would have refused to sign the paperwork I would have switched doctors. I don’t expect that any doctor would refuse to sign the paperwork.
Hi Sarah,
I’m with Helmut on this one. I think the CGM people should be willing to help fight the insurance battle. If you get them going, the Dr really only needs to sign the paperwork. One problem with this could be if you need to get a letter of medical necessity, since the Dr. will need to write that letter.
Honestly, if your Dr. isn’t willing to at least help, you might look into a different doc. Doesn’t sound like this person is particularly attentive to your needs…
If I understand correctly, your doc’s role is crucial but limited. He/she must certify you need the CGM via a letter of medical necessity. Switch docs if your current one won’t agree to fill out the letter of necessity. After that, if insurance denies it, the fight is between you and the insurance company. Your doc has already certified that the CGM is medically necessary so all you need from your doc at that point is a copy of the denial paperwork. Then you file an appeal with your insurance company which goes to a different department of the company, not their customer service department. Customer service can put you off, lie, forget, etc, but once you initiate a formal appeal by mail, there will be a paper trail and it becomes a contractual matter between you and the company. I forget who it is but there is a very knowledgeable person here at tudiabetes who has explained how to achieve CGM coverage.
If forget who wrote the following:
“Learn your policy. Keep a log–names dates and times of everyone you talk to, everything you mail and the cert#'s and return receipt stubs. Keep fax confirmations and mail everything certified mail that is important. When doing so make sure each piece of paper that you enclose in the certified mail has the certified mail # on it–this is an important step.”
The company will do the initial insurance paperwork and application for you. They have people on staff whose only job is to help you apply to your insurance company. But they won’t put up a fight for you.
My experience is that insurance companies are willing to pay for them if they help you avoid lows, but not to avoid highs. So be prepared to preesnt a log showing a couple of lows a week.
One thing you need to ask is whether you really need a CGM in the first place. Do you want it just to have one or do you have a plan for it. I didn’t have a plan when I got mine, but it was my doctor who recommened it. (I can have her call your doctor if you want! 
) Personally I don’t wear mine more than two weeks out of the month and not every month either. I use it when I’m starting to lose control and/or in the weeks before an endo visit so I have more data to confuse myself with.
Just consider whether it’s worth the fight.
Terry
Sarah,
The ‘Letter of Medical Necessity’ is like a multiple choice test. It is pretty easy to figure out what the right answers are. The big unknown is how many answers you need to get right so that your insurance company will approve a CGM. A company like DexCom who sees a lot of applications flow through is in a position to assess how likely it is that your application will be approved. Put a lot of effort into this test. It is difficult to retake the test. Once you have given the wrong answers it is an uphill battle. Of course, your answers must be truthful too. This is easier said than done. For example, I had no idea that I slept through many lows. If I would have known that before I got my CGM I would have scored more points. Don’t rely on your doctor for help in this battle. Your doctor has handled very few applications in his life time. DexCom handles about 10,000 applications per quarter. Your doctor has very little financial incentive to help you. People at a company like DexCom make a living out of fast tracking your application. CGM salespeople want to close a deal. This works in your favor.
Terry,
You brought up a very good point. The JDRF study points out that patient selection is critical for CGM success. Diabetics with good bg control benefit the most. Diabetics will bad bg control don’t benefit at all. The reasoning given is that good bg control can be achieved without CGM. Bad bg control indicates that these diabetics don’t use the tools that are already available to them and a CGM is just another tool that these diabetics will not use.
You can tell your doc. that I have had excellent luck with my MiniMed Paradigm 522 with CGMS. It is true that the CGMS shows TRENDS, moreso than actual BG’s, and if your BG’s are too low or too high most of the time, you’ll get a lot of beeps. I don’t mind, because I have severe hypoglycemia unawareness, especially during the night. Why not join the Yahoo! CGMS e-mail list. You’ll be able to read about loads of CGMS success stories there!