Hey guys, I'm about to apply for insurance (cigna) pre-authorization for the dexcom. Don't really have any idea what to expect. It seems like a lot of people have gotten the run-around from various insurance companies. Just wondering if any of you had dealt much with them on the CGM issue and had any idea what to expect, what might make them approve or deny, etc.
Thanks,
Sam
I don't have CIGNA, but I was very pleasantly surprised with my insurance company; no problem at all and a very reasonable copay. I'm so glad! And it makes sense because we use far fewer health care dollars when we have the tools we need to keep our BGs in our target zone more of the time! Good luck, Sam!
I have Cigna. I know each policy is different but... After submitting my logs, all was approved. Even better, it's totally covered with no copay. Mine is almost a year old.
I'm a little afraid they might see my logs and deny it because it is in "too well controlled" without it-- as if there is such a thing. How many months worth of logs did they have you submit? I've been diagnosed and on insulin for 5 weeks total at this point
One month of logs. I was in good control also but some random highs and lows. My dx was a little different - I'm older, originally dx'd T2, then tested and now a LADA T1. My Animas Rep is the one who shot all the paperwork through along with the endo.
I believe it's easier now than it was earlier.
I sent the logs from my Ping.
Wish you luck!
I have BC/BS and was mis-dx T2 when I got my first (just got the second). The Dexcom rep told me they would approve if I had documented lows under 50, which I did. Submitted a month's worth of logs.
I've had a few lows under 50 but not in the past few weeks.
Or I guess I could take a few shots of whiskey and some extra insulin each night before bed for a while to prove the point...;)
I was denied first, had to submit logs. I am on bcbs of LA. I was afraid i would be denied as well. I went through PumpsIt, and they took care of it all. I may be wrong, but i just don’t see how they will deny you, being type 1.
I had to submit a questionaire including number of times below 55. It also asked about emeregency room visits for hypoglycemia. My endo knew what to write. I have Aetna and was approved in two hours! My CDE said it was the fastest she had ever seen. I am covered 100% after deductables so it depends what claim hits first in the year.
How's the dexcom been working out for you? Would you recommend it?
Have you heard anything yet?
I've got Aetna, and being a T2 I had heard that it would be difficult. I'm on MDI and wasn't under great control. When I talked to the Dexcom rep, he told me I would need at least 30 days of logs showing testing at least 4-6 times a day with a few hypo incidents. Well, guess what he got??? :-)
My Dexcom was approved in less than a week. I haven't felt in this much control since being diagnosed over 12 years ago. I'm in much better control now and I don't think I would ever go without the Dexcom. Just the extra information is so worth it. To go from 4-6 data points a day to 288 data points is a wealth of information.
Best of luck and hope you get on the system,
Alan
No word yet, although apparently they called my house today, I'm out of town on business so they haven't gotten through to my cell yet. Pretty speedy actually since I actually just submitted my insurance info, etc to dexcom over the weekend. Did they tell you how low your hypos needed to be? Brad mentioned 55 or below was his requirement. What a silly world we live in-- Why do they insist on seeing hypos? The idea is to be in good control all the time--- not to chug whiskey and take too much insulin, and jump rope in a sauna until I pass out just to prove I need a medical device...
I started my first sensor today:). I did pay quite a bit for the Dexcom as I have a huge deductible, but I feel the cost was outweighed by what the CGM can do for me. Have you checked into just buying one, so your not a slave to the Insurance requirements?
How do you manage the ongoing cost of the sensors? I'd be willing to buy the CGM monitor myself if I needed to-- but the ongoing cost of the sensors would ruin me...
Thankfully, my insurance did approve the sensors, there is a cost to me of $50 bucks every two months(8 sensors). I must say I contacted Dexcom directly at the urging of a fellow at Animas, I received Laura Gonzales as my rep. Laura did it all, contacted the Doc, Insurance, Durable Medical Equipment provider, I mean everything. I simply had to say "send it" and I had it in two and a half business days. Laura placed the order on Friday midday, and I had the unit and sensors on Tuesday at about 1pm.
Let Dexcom work for you, they want to sell their equipment, so they will do all the leg work and make it quite easy for you.
Michael
Apparently with CIGNA they go through some third party group called Care-centrix or something like that. I really don't understand what role they serve, other than some sort of middle-man between the patient and the insurance-- hopefully it doesn't complicate matters. I'd be happy to buy the device if they'd pay for the sensors. What did the unit cost?
I like!
Yep, same thing with United Health Care, they go through Diabetes Specialty Center. It just has to do with the underwriting of various plans and contracts the insurance companies have with the "middle men." It doesn't affect the bottom line cost (for me at least).