Should I Purchase a CGM Out of Pocket for 295.00 or should I patiently wait for my insurance

When I went to my Endo last week he asked me if I was interested in the CGM. I let him know that I was, Me being the type of persistant person that I am…I called my Endo’s office today and I asked if the form had been faxed to Dexcom, the office MA said it was faxed on June 17. I let her know I haven’t been contacted by the company or even a Rep. She gave me the phone number to my local Dexcom Rep. I talked to him for a few minutes. He asked me what insurance I had…I told him Tricare. He said that’s going to be a hard one. I let him know that getting the Dexcom approved from a lot of insurance companies must be hard. The Rep asked if I waned to pay out of pocket because the dexcom is on sale for $295.00. I let him know I would think about it and talk to my Husband. I used that as a decoy to get the Rep off the phone. I am not going to talk to my Husband because he would buy system for me; I don’t want to pay out of pocket for something my insurance should be paying for and my Husband shouldn’t have too either!
My Husband fights for his country, I am not going to pay OOP for anything! I will fight with the insurance company , I fought for my OmniPod, I will fight for the CGM. Why pay when I can get it for free or for almost no Out of Pocket cost to me!!!

I have to go call the Dexcom Rep back



It seems to me that I’ve read on another site that Tricare pays for it. Let me look around…Anyways, I am in the process of fighting Aetna and I’ve acquired all kinds of useful info. If you are interested, send me your email and I will send it to you directly.


It will cost you more than $295 up front. That is just for the receiver and transmitter. You don’t get sensors for the $295, so be prepared to pay another $270 out of pocket for four (a month’s supply, or possibly to months if you can get 2 weeks out of each sensor). My insurance didn’t pay for the cgm, but they do pay 70% for the sensors, so that helps. Good luck!

I think that the reason that DEXCOM is so willing to sell the unit is, as Toni mentioned, that there are a lot more expenses that you would have to pay to just use the DEXCOM. I think that fighting for insurance coverage is worth it!

Don’t you have hypounawareness and nighttime lows??? You should get your doctor to write about those :slight_smile: I had REALLY bad insurance, but i got them to fund my pump after my doctor wrote about nighttime hypos. Make sure you tell your doctor everytime that you didn’t feel when your blood sugar dropped below 70 or when you went low during the night…

Maybe your endo has a loaner unit you can useto prove the hypos. We knew I was having hypos (I have unawareness), told him I felt like I was constantly on a roller coaster. But, until I started using the CGMS (6 days now) we didn’t know how many–during the day in between finger sticks. We have made changes to my insulin routine and eating pattern (I really need sancks between meals) I feel better and BG sure much better.It is kinda crazy–its almost like my body has day and night mixed up (night time being pretty level) with weird (fast) drops during the day. I am just thankful to be off the rollercoaster, as the CGMS warns when going low so i can stop it before I crash…

anyway,sorry for the ramble, jusst a thought , the loaner that is.

I don’t think you should pay out of pocket. Tricare paid for my CGMS (MINILINK transmeter) with little problems. I just called the Tricare claims office once a week to check on the status. I’ll admit, at first, I got a bunch of different answers from reps, but then I managed to get a rep who actually knew what she was talking about. The rep asked me for the CPT code of the CGM (which I got from medtronic site) and she instantly told me I was approved. I hope that us being in different regions won’t make a difference i.e Tricare South. Good luck, I hope you get a CGM.