Just got covered under hubbys insurance! How do I find out if they'll cover a CGM?

Hi guys

After 21 yrs of testing and paying up the *%#@ for strips I want a CGM, we just got covered under Blue Cross?Blue shield MN. I actually had a few tears when I saw how low the prescription costs were for my symlin and insulin and other daily drugs but I cant find anything about CGM coverage, any tips?



It should be listed under Durable Medical Equipment if you have a brochure of benefits or can access one online. If you don’t see it, just call them. Chances are it is covered as you are Type 1. I have Blue Cross Blue Shield in California. I know all policies are different but just for a point of reference I am on a schedule to cover 20% of my pump cost and supplies; I’m sure the CGM would be the same.

Like, ask them? There has to be a person who manages your account and your group, and will be familiar with what they cover and what they don’t, and what the qualification requirements are. But I hope you know that a CGM is NOT a substitute for fingersticks – it can give you info about trends, and alert for highs and lows, but you can’t make treatment decisions without that fingerstick. That’s because the numbers themselves are not that accurate, and if you correct for a 235 and you’re really 175, yeah, both of them say you’re high, but you might take too much insulin if you believe the 235, and that’s not a good idea, LOL!

It is usually covered under your Durable Medical Equipment benefit, and you can call your insurance co. and ask them about it, but my experience is they’re usually not super helpful because they don’t know the exact price of whatever CGM you want. If but if you decide which CGM you want though, you can usually have the CGM company contact your insurance co., they find out how much they’re contracted for with them, and then they’ll do all the math and call you back and tell you exactly how much it will cost you up front and then on a monthly or 90 day basis. I have BC/BS in Ohio, and it’s been really great in terms of what they cover, but each state is a little different. Good luck!

One of the many reasons I have no desire to get a CGM. That and the damn alarms waking me up, another device on my body and something else to obsess about…lol

Dexcom will figure that out for you (if you are so inclined). If covered, your insurance company will have a contract rate with Dexcom and a Dex rep will call you back and tell everything you might want to know about cost and coverage. My Anthem of CA covers it but the maximum sensor re-order they allow for me is 2 months at a time.

Oh, and this is before you commit to buy.

I agree Erin, a lot of times the insurance companies aren’t that helpful. If you want a Dexcom, I would call them. I think that they have to get a form filled out before they will contact your insurance company.

+1 for filling out the app with the CGM company. I tried to ask my insurance and they had no idea. Go through the company. If it’s not covered or not covered to the extent you need you do not have to go through with the app. I wasted a full hour trying to talk to BCBS of MD and they basically were no help at all.

I guess I have a very good ins. company (Washoe County School District, self-covered) because they have always been very helpful when I’ve called with coverage questions. And they’ve covered everything I needed without question although not without personal expense. I wish everyone were so lucky!

Natalie- I very aware of what a CGM does, as an actress and yoga instructor I know it will help me catch lows and highs better and with such an active lifestyle its really helpful to see the trends a CGM can offer. I wish I had insurance that had a person who actually KNEW me but I;ve given up trying to explain myself to the person who’s on the other line of a major insurance co :slight_smile:

Thanks don, I think this is the best place to start!

Thanks Lynne, this is the exact kind of info I was looking for :slight_smile:

Agree. Dexcom did all the work for me with both my doctor and insurance. I just had to cough up my deductible cash.

I had BC/BS of Illinois through my husband’s employer, and they covered the Dexcom 100% under DME. I now have Excellus BC/BS NY, and the Dexcom is covered 100% under diabetic. When Dexcom called Excellus they asked how much was covered under DME and was told 80%, so they wanted to bill me 20% upfront before they would ship my supplies. My employer has a rider that diabetic is covered at 100%, so I called Dexcom and explained it and asked them to call Excellus back, and they then shipped me the supplies with no copay from me. It pays for you to find out how your policy covers diabetic supplies, whether under DME or something else, so you know upfront before ordering.