HI! I’M RECENTLY HAVING MAJOR LOWS. ON 5-4 I WAS LOW AND PASSED OUT. I GOT UP CHECKED MY BS AND IT SAID 82 (KEEP IN MIND I DON’T RECALL DOING THIS) I TRIED TO GIVE MYSELF A BOLUS. MY HUSBAND LUCKILY WAS THERE AND WRESTLED MY PDM FROM ME.(I’M ON OMNIPOD) HE SUSPENDED MY INSULIN. THE OTHER DAY I WAS AT THE GROCERY STORE AND I JUST COLLAPSED. MY DR. WASN’T SURE WHY THAT INCIDENT ON THE 4TH HAPPENED. BETWEEN THAT INCIDENT AND THE FACT THAT I DROPPED TO 41 WHILE VISITING HIM HE WANTS ME ON A CGMS. I FOUND OUT TODAY MY INSURANCE WON’T PAY FOR IT. I HAVE BLUE CROSS BLUE SHIELD OF CALIFORNIA. I’VE ALREADY CALLED MY DR. AND TALKED TO BCBS. HOW CAN I GET ONE?
All I can tell you is that when my insurance company (Mountain State Blue Cross Blue Shield) denied mine I had the Minimed support team call them on my behalf . I don’t know what was said, but I do know that I am now wearing a CGM for the first time and it was covered by my insurance company.
The Minimed people are simply fantastic. I have no experience with Omnipod, but they might be able to do the same for you.
Since you are on the OmniPod you have a wide choice of CGM systems to choose from. I use the Minimed since it is integrated into my pump. But they also make a stand alone version as well called the Guardian CGMS. Navigator and Dexcom also make their own versions. You’ll have to wear another “pager” on your belt or wherever, but I think it’s definitely worth it. Especially since you have hypo unawareness.
Like Pavlos said, whoever you choose to go with (Minimed will probably have the widest coverage) have that company call your insurance company on your behalf. Also, get your doc to write a letter of medical necessity detailing why you need this. The guy that I worked with at Minimed called 6 different people and just wouldn’t take no for an answer. He finally got it approved.
If that still doesn’t work, then you can always pay for it out of pocket. Which can be pretty scary. The CGM system is super expensive. Just the sensors for a box of 10 Minimed ones costs $350. They are only FDA approved for 3 days use. But most people can get at least 6 days out of them. That can help minimize the cost somewhat. The Navigator or the Dexcom (can’t remember which) is FDA approved for 7 days. I don’t know if those can be “stretched” or not since I don’t use them.
So some research and talk to the reps. Keep nagging the insurance company and make the CGM company that you choose work hard for you to get it covered.
Good luck to you!
All I know is Medtronic. They will help you and I am sure the others would also. I have BCBS I did not get a denial but I am the odd one out one that. Your doc needs to fax the script to whoever your getting the CGM from like Medtronic or other manufacture. They will contact you and tell you what you need. I know you will need 3 months of blood sugar readings for Medtronic so start now you can go back 3 months if you have records. Also I wrote a paragraph about my problems and how the CGM would help. Hypo unawareness is a big one for approval. Medtronic is really good with BCBS they know what they want to approve the CGM. Hope this helps
We had a similar situation. When my daughter was first diagnosed she felt her lows but now is not. She’s gone quite low a few times and it’s quite scary, but her AIC’s were great and generally she is well controlled. We put in for one with BC/BS of Vt and were denied We appealed a couple of times and even though we had great letters from our doctor etc. they kept denying us. We had an appeal yesterday were we could go and present our case and they finally approved us. I would say, keep very good records. If you have a PDM (we have omnipod) where you can download your records. Keep a record of some of your lows and the situation around them. If you are doing everything right and still having unexplained lows. Our daughter was finger pricking 10-15 times a day and could be fine one minute and low the next. Good documentation and don’t be afraid to appeal. It can be intimidating, I requested copies of all documents and records relevant to our appeal and realized they were spending more fighting us than the CGM would cost. We wrote a good letter spelling everything out and faxed in all of our documentation before going into our appeal yesterday. We were able to answer all their questions. They had obviously read everything and were prepared to talk to us. I think finally getting before real people really helped a lot. Keep fighting. I think if more of us do it, they will eventually realize how important this is and make it the standard of care. It took a lot of time and was a bit of work but it will be worth it.
Also if you are on the Omni pod system. They are working with Dexcom and Navigator and will eventually be integrated into the PDM.