New Dexcom G4 Platium User

Diabetes Technology Glucose Monitoring
1

I have hypo unawareness and live alone so my BCBS insurance approved the starter kit but not the monthly supply of sensors. For those, I need to get a special exception to policy from the corporate office in New York for BCBS to cover them. I work for a large Fortune 100 company.

I am scheduled for my training on April 23, 2013 and Dexcom is suppying some sensors until my appeal for sesnor coverage is resolved.

Looking forward to have this device......it's scary not being able to recognize hypo situations. Latest example was just last week. I was at 55 and dropiing yet didn't feel a thing. That is scary!

2

yes it is scary and good luck with the exception.

3

Hi Marty, sorry to hear that your insurance doesn't cover the expense. I have Kaiser Permanente and they don't cover the G4 or supplies either. I am paying out of pocket, but to me it is worth it. Dexcom gave me the Kaiser discount rate, which was considerably lower than list price.

One thing you can do to reduce cost is to use the sensors for longer than the approved 1 week. You can hit Stop Sensor and immediately hit Start Sensor again without changing sensors, sites or transmitters. You do have to wait for the 2 hour warmup again. Some people have gotten as much as 4 weeks out of a sensor, although I haven't tried much more than 2 weeks.

4

in my case the baffling piece is BCBS had no problem approving the starter kit but not the sensors. why approve the kit but no supplies......

5

Hi Marty, I also have hypo unawareness and use the G4. I have BC/BS coverage through my employer as well but didn't have any trouble getting coverage for both. Surely in your case it's just an oversight that will be resolved quickly - you are right that it makes no sense to approve the system without the sensors.

I hope your experience with the Dexcom is as positive as mine has been - the peace of mind at night is priceless. I echo Eb that you can get more than 1 week out of each sensor. Even when you get your insurance coverage for sensor, I like to go 2 weeks with my sensors because the accuracy seems to be even better at that point and it gives you a few surplus sensors in case you have a mishap when inserting one.

Good luck to you and let us know how it goes! :) By the way, the Dexcom users group here is quite active and very helpful.

6

I had to appeal in 2009 to get approval for the Omnipod system. Company changed BCBS provider to Anthem from Empire. I had to get re-approved to use Omnipod. Now this. It’s just the insurance company run around as far as I am concerned. Certainly no logic in any of it.

7

Because for the insurance company, it’s really just all about the money. They want to discourage your appeal and hope you won’t persist. It’s despicable! Studies have demonstrated that wearing a CGM 24/7 will lower your A1c while minimizing hypos. Don’t give up with the insurance process. Wearing my CGM has been one of the best things I have done for my diabetes. Good luck.

By the way, I have BCBS of Illinois and they covered my CGM and supplies without a fight.

8

That makes no sense at all to approve the starter kit but not the supplies for continued use. I would appeal that decision.

9

That does seem odd. Do you know if the device was covered as DME, and you possibly have different coverage for supplies under a pharmacy benefit ?

Did you check with your employer (HR/Benefits dept) ? Often they can help with clarifying what benefits are covered for employees.

10

I have had hypo. unawareness for at least the last five years. I have been T1 for more than 61 years.
Thank God my wife learned to handle bad hypoglycemic episodes or I would be long dead. She even taught herself to give me glucose injections when necessary.
I often had low sugars which is a side-bar to keeping your sugar under control. Since getting a CGM going on three years ago I have not had even one serious low sugar event.
The CGM, in my opinion, is the best diabetes improvement since beef and pork insulin became available at the retail level.
My HAP Ins. (Detroit area only) covers everything.

11

I got approval and received everything last Tuesday. I started using it the same day. It already earned it’s money tonite.



I got up for work around 9 pm and checked the Receiver. It showed around 90 or so. Started watching TV and I was feeling pretty good.



All of a sudden the Low Sugar Alarm went off. My BG was 55 and dropping fast.



I had not felt a thing to indicate my sugar was dropping rapidly. No signs at all.



Thank goodness for the CGM! Who knows what would have happened next and how soon.

12

Its an HONOR to know someone who has had Type 1 for 61 years! Gives me hope!!
I am only at 25 years.

Laura

13

Thank you, Laura. I have been both fortunate and am blessed to have a history of longevity throughout my family.
Keeping my A1c at a reasonable number has become sort of a game to me. This works for me.
My CGM has ended the most frustrating part of the entire condition.
I find myself irritated when my T1 is referred to as disease. I prefer to call it a condition, for when I was a youngster people commonly said, "Your disease will prevent you from living a long healthy life". I'm determined that my condition will no more shorten my life than being born with only one foot. In my opinion both are conditions, not diseases.
I appreciate your response.

14

I just want to testify that I also do this and haven't had a problem..There was an initial learning curve problem for me..ocassionally one does break or come broken...the little transmitter placement lever is a wee bit delicate...and Customer service was a comedy of errors for me for the first months..The actually sent me the wrong sensors which DO NOT WORK with the G4 but look the same so always check :) ...

BUT now...all is well. I love my G4...Recently it broke somehow, the buttons fell off while I slept and I awoke hypoglycemic with the alarm blaring away! And because the buttons had fallen off I couldnt turn it off LOL...(must have been sweating a good deal) They shipped a replacement overnight!

As stated above, now that all has calmed down, and I am confident and capable. I leave my sensors in three to four weeks using the method above...I do need extra adhesive booster tho...as bathing and showering definitely loosens the sensors stock adhesive...

The very best of luck to you

15

:) Best Thing that ever happened for me!..The one night I didn't have it was a very strange feeling to worry again. Don't forget to calibrate...And please know...that every once in a while the interstitial blood can be different once in a while by quite a bit from your finger stick...They recommend that we never make decisions on the CGM alone...More than once I have found that I wasn't nearly as hypo as it showed... Again, the best of luck to you! So glad it came through!

16

I'm just getting going on all this (starter kit just shipped).

Have Anthem/BC here in CA, and not one of their more deluxe plans (small company, can only afford to offer high-deductible, copay-based plans).

Still, A/BC approved the whole shebang, and I don't have a special circumstance (like hypo unawareness) to justify it. I'm going CGM simply because I want to achieve non-diabetic BG levels of control.

Only "condition" had to meet was having at least one hypo episode below 50. I've been in the 50s once, but not under. We fudged it, given the accuracy my GCM, my 52 very well could have been 47 (52 +/-5), so we went with that. They took it.

Short-sightedness is such an epidemic with business. I am not a supporter of Obamacare, or government sponsored/run health care generally. However, I do support regulation that changes the economic calculation so that it is in an insurance company's financial interest to plan and operate on the long term rather than the short term.

As it stands now, future costs avoided due to smaller aggregate spending now just doesn't figure in the calculations. The fact that doing (relatively) expensive CGM now and avoiding hundreds of thousands in costs later to deal with complications doesn't register, because there's no surety you'll be their customer then, and they'll have to pay those costs.

They have to satisfy their shareholders today, not prospective shareholders 20 years from now while you're having amputations, heart bypass surgery, laser retinopathy treatments, in-home care assistance, and on and on -- because you weren't able to get a CGM earlier in the disease and keep it under good control.

I don't know what the public policy answer is. I have a few ideas, but nothing I think american society would ever be willing to adopt.

17

What a psychologically healthy attitude!

I'm adopting it.

What is crazy is that if every diabetic were put on a CGM, the overall cost of diabetics to the health insurance industry would likely go down -- a lot.

18

Ahmen to that. More often than naught caveman machine and strip saved a panic as cgms got out over the dock. YET when it was on, sure saved a nother problem and provided extra guidance.