Suggestion: get an rx for the dexcom sensors. attempt to have it filled under your insurance. If you are sucessfull, call dexcom, and see if they will give you the $500 starter price that they have been giving ex-navigator users. then you would not have to mess with the insurance. I got the Dex, and tried for many months do get reliable readings, then finally bought the nav out of pocket, after checking and getting the Nav sensors, instead of the dex. I am now back on the Nav, and ins is paying for the sensors. I could not ask for the Nav CGMS unit, under my policy, since the CGMS itself is no longer available for USA purchase. BUT the SENSORS ARE, and insur IS picking it up.
I would make sure to somehow convey that the good A1c is due to far too many lows, especially overnight when not using a CGM. It might be a bit tricky since they have already been paying for the sensors, but I’m pretty certain that your Minimed is way past warranty also?
back in 2006, shortly after both devices were approved, I tried them both before going with Dex.
For me, MM spat out random numbers for one or two days, and then went to “failed Sensor”. Dexcom STS (I started with the 3-day model) worked VERY well for me, and I’ve been using it ever since. But I also know many people who get fantastic results with MM, and Dexcom has not been shown to be “more accurate and reliable” in a general way.
BUT, it is widely reported that Dexcom is faster and more reliable at catching Hypos. There is also a technical paper, in which the researcher was supported by a Minimed grant, where he concluded that the software, more than the Sensor technology, would prevent many ISIG patterns of “falling into Hypoglycemia” from showing a problem – and he had access to the source code, and specific ideas to make it better. The new Minimed Sensor is a lot different than the current one (the code to translate the ISIG datastream into bG readings probably incorporates the recommendations of that paper). It’s much thinner. That’s (in part) because the nylon “wrapping” of the currente Sensor is replaced by a thinner metallic surface – more like Dexcom. But it’s still in PMA, and I don’t really know much of anything about it – what I’m saying here is mostly SWAGs.
Please friend me, there is a lot to discuss. BTW, I lived in Mpls for many years, and Columbia Heights for a few.
They don’t know, and to the extent that they could guess, they can’t do so privately. (It would be SEC “insider information”.)
That’s exactly what I’m thinking of doing. I am going to talk to someone at my insurance tomorrow to see if I can get some useful advice. But then my first step might be to just order the sensors from Edgepark and see what happens. I do have an approval and prescription for CGMS sensors on file with them. Edgepark lets me order whatever brand of test strips I want, so maybe it will work the same way with sensors. I doubt it, but it’s worth finding out.
Thanks for the info on the starter price for ex-Navigator users. I would hope I could negotiate the same deal to become an ex-Medtronic user. Obviously they companies make enough money on sensors that you wonder if someday they’ll give the transmitter and monitor away the way we now get free BG meters knowing we’ll pay up the wazoo for test strips.
If the last time you received a new transmitter kit was 2 years ago, it’s no longer under the manufacturer’s warranty so it won’t be covered if anything happens to it. So you are definitely eligible to submit to your insurance for another cgms. Have your healthcare provider who’s writing the letter of medical necessity state that the warranty on your current cgms as expired, definitely mention that you have hypoglycemia at night, also if you have hypoglycemia unawareness and if you’ve been at work or school and you’ve needed assistance because your blood sugars were dropping or increasing rapidly that gets the health plan’s attention. If you have blood sugars over 200 when awakening and/or any complications associated with diabetes such as retinopathy, neuropathy, etc. Finally, mention that you’ve been using a cgms — that’s usually justification for another one. The insurances figure that if it was covered by another health plan, they will usually (not always) cover it, also. Hope this helps!
Actually, Edgepark IS the supplier for my insurance. The sensors are interchangable for billing purposes, sent by month supply ( 4 on Dex, 6 on Nav) and with the rx for both, you can even order one month of one kind, then one month of the other, useful if the Nav breaks, and you need to temp go back on Dex until out of country unit shows up again.t
Update today is that I followed your advice and just order the sensors yesterday. They are already being shipped so you’re right that the sensors are interchangeable.
I’ve given Edgepark a call this morning and am waiting for a call back from a “specialist” to get the process on the road for the starter kit. I gave my doctor a packet with a four page medical justification from me, including blood and gore photos of bloody sensor starts and bruising. Hopefully it will just get approved, but I’ll file an appeal if necessary. And then at the worst, pay for it myself since I know the sensors are covered.
Great !. The insertion problem with pictures is a great idea – pretty certain the health plans don’t see that very often! Thanks for the status update!
So final status - did the insurance cover? I hope so I love my Dex and I am sure you will too!
The insurance definitely covered the sensors as I was told they would. I ordered the Dexcom sensors from Edgepark on Tuesday and they were at my front door on Thursday.
I talked with the Edgepark “specialist” about ordering the starter kit. She has started the process of faxing my endo the info that needs to filled out and then doing whatever needs to be done with my insurance. She asked me lots of questions on lows, highs, dawn phenomenon, hypo awareness, etc. She indicated that it would take about a week to get an answer.
Although the Edgepark woman was optimistic about it getting covered, I would think at best I have a 50-50 chance. I was told that if insurance won’t pay for it, I will still get the insurance contracted rate. I will figure out whether I can get a better price from Edgepark or Dexcom directly and buy it out-of-pocket. My preference would be to buy it from Edgepark because then I could launch an appeal with insurance after actually buying it out-of-pocket. Dexcom is not an approved vendor for my insurance. If I buy it from them, there is no way that my insurance would ever pay for it.
I know that you love your Dex and I hope I have the same experience. Although I never had a great experience with the Medtronic system, I did love having it integrated with my pump. For me it will be a step backwards to have a separate receiver with Dexcom, but I know I’ll get used to it. I just know that my pockets aren’t big enough for a phone, car keys, pump, glucose tabs, and now a Dex…
Yes us guys have it so much easier with more and bigger pockets and no concern about maintaining an attractive shape! I still refuse to buy a shirt without a pocket - I think I started that as a smoker (long time ago) but now the shirt pocket is a convenient place for my dex and easy to get at regardless where I am. If i am driving, I will putit in the console to keep handy
Unfortunately, whether your transmtiter is in or out of warranty has nothing to do with whether your carrier will pay (or contribute to) its replacement. When it fails it needs to be replaced. If that occurs within six months, the manufacturer’s warranty covers and you simply get a new one. If it’s outside 6 months, no different than your car, you “buy” a new one. If your insurance covers, it gets paid for.