First of all, I know all insurances have different relationships with all of the suppliers,
I am wondering something. After doing some pretty intensive research I have come to the decision that I want to stick with minimed on the pump side. I have never jumped in to the CGM aspect... yet. I would like to get into CGM but from my research I do not want to work with the minimed CGM's until they can better suit the diabetic community. I am a fairly thin individual (6.5% body fat) and so I was leaning more towards the Dexcom CGM. I also like the fact that it would not transmit to my pump itself (i have a fear of machines taking over and would hate for my pump to be my demise)
Which leads to my question, Will insurances cover a dexcom if i have a minimed pump? Or do they usually prefer you stick with the same brand as your pump for CGM's?
You can usually get a doctor to write a "letter of medical necessity" for whatever you want. It typically takes a bit longer but I think that most people are able to do it. I have worked through my doc but, when I wanted the CGM (I have the Medtronic...), I called them and they did everything. I don't recommend calling your insurance and asking them because the whole process involves something like chess and the doctor will work with the CGM company to get it done.
Thanks Mr Acid :D That is how I did the "pump dance" nearly 20 years ago. Just let the doctor deal with all of the shenanigans. How do you like the Medtronic CGM?
I like it pretty well. I don't seem to have the problems with it that a lot of people have although I have to concede that they don't last as long as the Dexcom sensors so they will likely cost more. I dropped my A1Cs using it and have enjoyed how handy it is for running & bicycling and everything else a lot. It is also very useful as a resource to make adjustments, find patterns and all of that. I'm a big fan! The new models (Enlite) are more accurate. I've only used it 3 weeks and had an odd first week, I think b/c I had sort of "programmed" my head to work around the lag time of the older model. I'm constantly shocked by how often the CGM is at the *exact* number my meter is at. The needle is also way less intimdating and more comfortable than the old model.
I did it a bit differently when I got my Ping. I contacted Animas and they did everything for me. When the doctor didn't fax back the info promptly they actually had someone go to his office and wait until he did the paperwork! For me that seemed to work as I just see a PCP and he wouldn't have a clue what to put on the paper regarding basal doses, etc. I also figured out the pump company was well motivated to make it happen due to the $5,000 it brings them...not to mention pump supplies into the vast future!
I've been with Minimed for 12 years, and I just inserted my first Dexcom sensor about an hour ago. Insurance paid for it. I've used the Minimed sensor before, and hope I get better results with the Dexcom. Talk to Dexcom. They are used to dealing with insurance companies.
I use an Animas Ping pump (no integrated CGM option like MM) and a Dexcom CGM. I let each vendor deal with the paperwork and my insurance covered both items. If you like the integrated pump/CGM idea, be aware that Animas expects to release the Vibe pump/Dex CGM hardware in the US next year.
I really like the Dex CGM. I make use of the data upload capability to both the Studio software and third party web-based Diasend. Diasend is unique in that you can view most pump, Dex CGM, and most meter data in one combined report set. MM is not compatible with Diasend.
I agree with everyone here that having Dexcom contact your insurance company is your best bet. Trying to navigate your way through your insurance carrier yourself typically is a waste of time. There are two main things that are of importance. The first is how the contract your insurance carrier has with any vendor is written (they are all different.) The type/level of coverage was already determined by your employer when they decided to offer whatever insurance company you have. Just because Blue Cross/Blue Shield (for example) covers supplies for one company doesn't mean they will cover it for another. This you cannot change. The second item of importance are codes/diagnosis codes. Dexcom will have these-you won't. If Dexcom talks to your insurance, they will be able to give them the correct codes to get a medical device covered. And trust me, Dexcom will be HIGHLY motivated to get you covered. Not just for the CGM, but for all the sensor supplies you will then be reordering from them on a regular basis-that is where they truly make their profit. Let Dexcom do all the work for you. Odds are, your device will be covered. Good luck!
