Dexcom made me provide TONS of evidence to support the need (they actually asked for a trumped up letter from my endo saying that it would be a lifesaving device for me. I'm all for it, but I lived for over 15 years with D without it and made it. Yes, it helps, but I'm not going to lie to get insurance to cover it. sheesh, dexcom! Oh, and why do they not overnight the replacement receiver to me when it failed if it's so necessary for my well being? Just sayin'...). My insurance (BCBS of MD) approved it within 15 minutes, so I'm SURE they carefully reviewed all that information Dexcom made me provide :)
Thanks for your input! I hope your Dexcom improved on your prior 15 years of dealing with T1. My experience was similar. The very best to you in going forward!
My son's Dexcom is fully covered, but we had to file an appeal because the standard answer from insurance was that he was too young for it to make a difference. I used some studies primarily from JDRF to prove that it was useful and it was approved. (That was when he was 9 years old and now he's almost 13) We have Tricare which is military-based.
I like the dexcom a lot. I cannot imagine having the ability to fine tune my basal rates without it. I think I catch trends way more easily. However, I think I lean on it to catch my lows and often don't "feel" myself drifting that way until the dexcom alerts me (if that makes sense at all!). I use it like a crutch, so it has become one in a sense. But I don't want to get rid of it! ha!
--> 54 years old. --> T1 for 31 1/2 years.
--> I'm on an 80/20 plan through Cigna with a deductible.
--> I actually don't know who's covering my unit as I submitted for it thru Dexcom who were in contact with my Endo. I've never had any contact with Cigna regarding it, though possibly Dexcom has. In any case, it is covered 100%.
--> Dexcom 7+ and then G4 since October '11.
What are you planning on doing with all of this info?
I am glad insurance made an exception for him! It is essential for any T1, but especially the younger ones. If the youngsters work computers better than their older family members, they can work the CGM just fine ...
Thanks for the info and glad to hear that you've gotten it covered! And I am sure you know what a difference it makes. If most are covered, nothing needs to be done. If there is a large group who are not getting coverage, start a campaign to convince and/or persuade insurance companies to cover it routinely. That would need ADA involvement. So far, as you see, most are covered. May be it's a selection bias, because this group is a "user's circle", but what about those who were denied? They would not have much of a reason to be on this bulletin board. They are the ones who would need help. But I am not sure one can get a feel for how many of them are out there. So far no one on in this circle is completely paying for it out of pocket.
Except for Richard 157 who pays for it completely out of pocket - T1 for 67 years but Medicare won't cover it. Which I find nothing short of repulsive.
Cannot agree more! I wounder if we could submit our comments on his situation to Medicare? It is hard to understand why would they not cover it ... well besides the expense of it. I don't think they are as much concerned about saving in the long run as not spending in the short run. I also noticed in his reply that he is only able to afford 3 sensors a year! That's just sad. Could we see if those who are able to extend their sensors past one week would be willing to donate extras to him?
The big issue is getting Medicare to cover it. They won't, because they call it "precautionary", i.e. it's not supposed to be used to make treatment decisions. But that's not the point. The point, for me, is that I live alone, and I don't feel hypos until I'm in the 40's and 50's and by that time I might be too mentally out of it to treat properly. Medicare doesn't understand that the Dex is a lifesaving device for a lot of people.
I would argue further that in addition to protecting against lows, CGM changes your quality of life. Non-diabetics can't understand what it is like to live with bg that can change so frequently according to food, activity, illness and stress factors. For sure, diabetics can thrive without CGM but now that it is available... I suppose the same issue of coverage will arise with future Artificial Pancreas which I predict will not be affordable for the majority of PWD's. Even now only a minority of us use pumps.
mtulchin, some friends who have upgraded to the G4 have sent me a few of the old Dex 7 sensors. Even the ones that have expired work as well as the ones I used to get that were new. My sensors were covered a few years ago, before I started with the MVP/Medicare plan.
