I go to Joslin Diabetes center and the company where I get my supplies from told me the only way to get medicaid to pay for it is to go through what is called I-pro test. I am still waiting to set up the appt (I sent the email last week and no word yet).
Has anyone else done this?? I really cant wait to go back on the CGM...It will help me a bunch
Hi Amy,
The I-Pro is the Medtronic version of the CGM. It is a sensor which your CDE inserts on you and you wear for 3-4 days. You do not get a receiver and you do not have any information from the sensor you go back in to the clinic and remove the sensor then your CDE plugs it in to their computer and reads your CGM data. Then they match it up with your log of food and insulin doses or pump data.
My endo wanted me to do it because my A1C came back as 6.1% after having been at 7.5 for years and years. He was worried I was missing a lot of lows. As it turned out he didn't have a clue that I had really worked hard to get my A1C lower.
I didn't get a lot of information from the I-Pro results. What I learned though was that if the medtronic cgm sensor was the only one available I would never use it because it was uncomfortable and hurt a lot on insertion.
I do have a G4 and my insurance covers it 100% I am not sure about medicaid. But I also go to the Joslin Clinic, only it is a satellite clinic in the burbs.
I would suggest you contact your CDE at Joslin about this.
Interestingly, IPRO stands for two things which might be what the supplier is talking about:
Island Peer Review Organization, http://en.wikipedia.org/wiki/IPRO, as well as Minimed's I-Pro which Clare mentions.
My daughter did the Ipro trial (as it is called here) and she wore Medtronic's version of the CGM for 5 days. We did not get the reciever either. After 5 days we removed the Ipro and mailed it back to the hospital as requested. During that time we had to keep of log of blood sugars and a log of the food she ate to mail in with the Ipro. The Endo then matched the Ipro results with the food/blood sugar logs. You don't have to do anything special while on the Ipro other than keep the logs. You still eat, sleep, shower, etc the same way. My daughter said once it was on, she didn't even notice it was there. Good luck!
medicaid will cover it 100% if I do the I-Pro test. Now I should start logging my food with the # of carbs and my BG before and after. I forgotten I was suppose to do that.
I'll take a look at your link to see what its all about. I hope the info will help with what they need.
Thanks...I guess I should find my food log notebook that I had to do before I went onto the pump (which took joslin 4 months to get me go onto the pump). I really miss being on a CGM so I can see oh that combo of food is a no-no for next time or that is good, I can see a steady progress.
When my CDE inserted the sensor she gave me some sheets to fill out. They are just your normal log of insulin doses, time that you took it, carbs that you ate, exercise and activity, lows that you felt, general stuff. They gave me a glucometer and strips to use with the I-pro. So I would call the clinic or email your CDE and tell him/her you need to do the I-pro test to qualify for the G4. The link Bill Quick supplied is for I believe a medicaid/care review organization in NY State. I see you are in Massachusetts, so I think the I-pro test is the one that I took.
Hi Amy. I had to do the same thing as well with the PCIP Insurance. I've had the Dexcom 7+. But haven't used if for a couple years. But I wanted to start again with the G4. And even though I had sued one before they still made me do the 3 day test. I believe it's to see how well your currently controlling your BS. Somebody from Dexcom should contact you and sending the unit and sensor with minor training. Good luck.
They should provide you with the logs when you get the Ipro. I recall Medtronic's logo on the top so it should be the standard log they use for all Ipro users. I think they want insulin dosages on there as well.
Sadly, Medicare will NOT pay for a CGM. It does not matter if you are a T1D, T2D, do NOT feel highs or lows, have been to the ER for highs, lows, DKA, or if the I-Pro shows a need. It does NOT matter what the results of the antibody test or the C-Peptide. It seems like Medicare would rather you die then pay for a CGM that could help in prevent the cost of ER, hospital and ICU stays, D complication cost, etc. I am very glad to have Medicare but miss the coverage I had before BS/BC became my secondary insurance :/
Good luck with Medicaid.
They need info from my endo. They did ask what color I want. I am going to pick blue as I hate pink and black is eh. I was hoping for green to match my pump. I'll get excited once I am back on it and can really get back on track in controlling my diabetes better like a few years ago
BCBS wanted 2000.00 up front and it wouldve of cost me 400/month for supplies. I no longer have insurance through my job as the 90 grace period has ended almost 2 weeks ago.
I was told by my rep from Neighborhood that I have to do the I-pro. The dexcom rep that I am working with needs info from my endo. So I am just waiting for all of that to go through. Before I went onto the CGM a few years ago, my A1C was close to 10%. While on the CGM I went down to 7%. Right now I am at 6% but my BG is way off to be 6%. So my endo knows I had better control on the CGM. So we are working on getting me a newer one.
Amy, just a quick FYI, I have NHP (MassHealth) and they are covering 100% of my CGM costs (just got my Dexcom in the mail today). I also go to Joslin, and I believe all my endo had to do was fill out a prior authorization form, BUT as a note, Dexcom does NOT have a contact with NHP (or any MassHealth program I think). I had to go through a third party company that Dexcom referred me to, but I had no idea that MassHealth prefers third party vendors and had been paying out of pocket for pump supplies through Animas beforehand...had I known I would have saved a significant amount of money in the last few years :(
Message me if you want the name of the third party supplier (I don't want to advertise on here and I can't necessarily vouch for them other than the fact that I got the CGM and the first 3 months of supplies for nothing). Good luck getting your CGM! Joslin is big on getting us on them, so I'm sure they'll help you get it any way you can.