Insurance classification for CGM

I’ve been “pumping” for sixteen years but only finally decided to go on CGM this past summer, and I must say that I really love seeing a flatline! Anyway, I realize that all health insurance plans are individual and quite different but I wonder if I can find out from you whether your sensors are covered through your “medical” benefits or if they are considered “durable medical equipment” and covered instead under pharmacy benefits? I’m sorry if this seems like a way out there question; I spent time talking to my insurance rep this morning and she said that the CGM may be still be considered “experimental” in my plan and therefore not covered without the huge pharmacy co-pay…

It got me thinking whether this is a typical situation for others on CGM. Thanks!

Mine are covered under DME and don’t apologize for the question, it’s not way out there at all!!!

Ok, thank you! I just didn’t want to bore everyone with those “blah blah blah” insurance terms, haha! I appreciate your support for the question.

Mine are covered under pharmacy benefits.

Mine are covered under DME, which worked for me this year since DME are covered 100% after my deductible and I blew past it with the purchase of my pump. Next year will be another story as I have 0% coverage before I hit it :frowning:

When I first got the CGM, the device and supplies were covered as DME, for which I had a straight 80/20 split after my standard deductible. When I changed jobs and insurance, supplies were covered as DME the first time; however, this insurance has a separate $1500 deductible! When I called for more supplies, they informed me that that could cover them under pharmacy ($60 copay). Since then, my supplies with this insurance have been covered as pharmacy - though not without an annual battle for coverage altogether!

All of my pumps over the years, and the CGM’s are covered under DME, from a variety of insurance plans that I’ve had.

Mine will be covered under medical benefits, with our secondary insurance picking up most of the balance. The approval process appears to have gone smoothly since I have had problems with exercise lows.

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Dexcom advised me to use an online pharmacy instead of going through DME and recommended Foundation Care. I have been using them for several years and highly recommend them, their CS is great. Dexcom can let you know what would work best with your insurance.

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