It is my firm conviction that CGM is essential for T1s. The insurance companies do not seem to appreciate it, judging from some posts that I see on this and other sites. This needs to change. But first it is important to understand how common is this problem.
If you could send a note indicating whether your device is covered by insurance or not, it would be very helpful.
My insurance company covers the Dexcom 100% without any copay at all. They also cover my Omnipod 100% and all I have to pay for is the insulin to put in the pods. Which I get mail order 3 months supply for $60.00. I guess they figured out it is smarter to pay for a Dexcom and avoid the ER visits for hypoglycemic events and ambulance rides. I haven't had either in a very long time but am somewhat hypo unaware so it is covered.
Iām covered at 40%. Gov employee with bcbs.
Did you have to support the need for Dexcom? Such as showing how many times you ended up in the ER or called the ambulance. That's what I had to do in 2010. Thanks for taking your time to answer the call!
Thanks for letting me know! Does that mean that you pay 40% of your sensor monthly cost?
Before I went on Medicare, my insurance was covering it at 80%. Of course, Medicare doesn't cover it. Now they're my secondary, and I still have to find out it they'll cover it at the same percentage or what.
I am covered at 80% same as other medications. I did have a history of lows, but I am not sure if they even called my doctor about it. Since my control has improved so much, I think it was a great move. My A1c went from 8.7 to 7.1 in a month. I can't wait to see what my A1c is next time.
I am very happy to see your success! Thanks for your input.
Thanks!
Correction ... you must be paying 60% of your device and supplies, right?
I've got 100% coverage on all DME including my dexcom and sensors. I needed to fax blood glucose records but have never needed hospitalization documentation. I'm on Keystone Health Plan East (a Philly version of BCBS).
I have Oxford freedom and they cover it 100% after I reach my deductable of $2500, which I do after about 2 months with the cost of insulin etc. Not sure what my dr had to do but my a1c was 11 for many years. went down to 8.1 after 6 months using dex. I have to use edgepark to get the supplies
Looks like my insurance is going to cover 80% of the Dexcom with no deductible. Still waiting for final authorization though.
All told, with Omnipod and various meds, it looks as though everything is going to cost around $350-400 a month out-of pocket.
Still cheaper than trips to the ER for either DKA or hypos.
In the covered 80% beacket. I wish Dex would cover 80% as full since they are doing so well . Never happen in this life I imagine?
I did not have to show anything to get the Dexcom covered. I believe as far as Harvard Pilgrim Healthcare is concerned just having T1 D is enough of a reason. I didn't have to provide any proof to get the omnipod either.
My daughter has been using Dexcom for 3 yrs. It's an off-label use because she's <18, & insurance did request 3 months of logs. They cover at 80% after deductible.
That's a sensible insurance policy - take care.
It sure did wonders for you and we are happy to see it! My insurance deductible works about the same for me and I too go through Edgepark, which works real well.
Thanks for your reply!
The best of luck with your efforts!