POLL: Does your insurance give you a hard time when trying to switch to new diabetes tech?

#1

Does your insurance give you a hard time when trying to switch to new diabetes tech?

  • Pretty easy
  • It takes a couple of phone calls and appeals
  • Extremely difficult
  • I tend to wait until the hype has slowed down

0 voters

#2

Can you give examples of “new diabetes tech”? Still wondering what tech is there that is considered “new”? The latest pumps and CGM’s have been out for quite a while.

#3

It varies a lot.

For new items, it may be employer or plan admin hasn’t included in plan yet. So it takes time for that.

If just new tech to me, but been around for a while, it may go through without hassle if MD prescribes it. Sometimes the MD is the bigger problem, when you are already “doing fine” with existing tools.

#4

My insurer has a CGM medical policy (copied below) that causes insureds to jump through hoops for coverage. I think a CGM should be automatically covered for anybody injecting insulin.

IV. Use of a long-term CGM device and related accessories and supplies are considered not medically necessary and not covered when the above criterion III. is not met, including but not limited to:
A. Type 1 diabetics not on insulin or taking only basal or bid insulin
B. As a convenience item

V. Use of a long-term CGM device and related accessories and supplies are considered investigational and not covered in all other situations, including but not limited to:
*Note: This policy does not apply to patients under the age of 2 year for whom long-term CGM use may be considered medically necessary and covered.
A. Non-pregnant adults with type 2 diabetes
B. Individuals with gestational diabetes mellitus (GDM)
C. Children with type 2 diabetes
D. Individuals with compliance issues

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#5

I agree with that sentiment.

2 Likes
#6

I’ve never had any real problem, but I’ve been on an insulin pump & CGM for so long my parents did most of it when I first started, so I can’t say for sure. When I got my current insulin pump (670G), which includes Auto Mode (that closed loop stuff), I was basically due for a pump upgrade anyway. So I’ve never really had any “new” technology that they refused to give me, so I don’t know if they would or not if new stuff came soon.

#7

I haven’t had any major issues with anything I have tried. It is not always paid at best pricing but they still have covered everything. Going off label is a little more but they still cover it. So using Victoza was a little more but worth it. And all my pump and CGM requests have been covered, no problems but it does help having type 1 vs type 2.