I didn’t know how to update the title of my previous thread so I started a new one.
I just got a call from BC/BS, the medical director has approved my appeal and my Dexcom is again approved at 100%, which is what they had been paying for my sensors before they decided to deny the replacement Dexcom after my one year warranty was up. What a huge relief! I asked her if I will have to go through this every year, and she said if I get a different device, I should call Utilization Management first to get prior approval.
Agreed. Funny thing is, I called Dexcom to order the sensors this morning. I got a call back, and was told that BC/BS said I was covered at 80/20 . I called BC/BS and was told that when Dexcom called to verify coverage, the rep told BC/BS he needed to know what my DME coverage was. My plan covers diabetes at 100%, not under DME. I think (hope) it’s finally straightened out, and the sensors will be shipped as soon as BC/BS faxes them the paperwork.
I suppose I should be grateful that insurance doesn’t deny insulin coverage??
Richard, I have heard that Medicare won’t cover it, that’s a shame. I truly believe that it is a lifesaver for type 1 diabetics. I was prepared to pay out of pocket for it if my appeal didn’t go through. The alternative is having lows all the time, or having my blood sugars run high all the time to prevent lows. My son went that route, and now he has severe neuropathy and is losing his eyesight.
Do you have supplemental insurance along with the Medicare? I am 61 yo, and am wondering if I continue my insurance after 65 as supplemental, if it will still cover the Dex? Of course that’s 4 years from now, a lot can change.
Thanks Sue, I have Medicare and an MVP plan. MVP is part of Medicare and offers more than straight Medicare, but they will not cover CGMs. I managed to stay healthy without complications for 64 years before using a Dexcom, so I guess I can do it some more years.
Sue and Richard,
Coverage after 65 depends on which supplement/company you have. Richard seems satisfied to go along without cgm, since he has always done a good job of management. But for you, Sue, I would definitely review the supplements available before you sign up for Medicare, when the time comes.
I stayed with BCBS in my later adult life because of their diabetes coverage. I know some BC companies do not do well on that but I was fortunate to usually be in a hospital or university setting and they usually had good BC contracts. So my supplement is BC from my previous work. I pay dearly for the coverage but hope that it evens out, given the cost of diabetes pump supplies. And cgm, which I hope to get a bit later. I have been told that my supplement contract will pay for it, by them when I called.
I know that coverage is changing so who knows what it will be in a few years.
