I can’t help but wonder how much the statistics on continuous use have to do with insurance not wanting to cover. At a recent workshop, we were told approximately 35% of kids end up using CGMs only part time, or not at all. If you consider the total pay out, that’s a huge waste. No statistics were mentioned for adults, but I’m curious. Of course, just as with pumps, there’s a serious lack of education available. Many people I’ve spoken with since my dd started with Dexcom are surprised (& maybe disappointed) that’s it a little more complicated than just hooking up the device.
Currenltly on COBRA with plan thru BCBS IL - 100% coverage on all DME including my Dexcom G4 and sensors. Approved several years ago after 2 initial rejections by same ins. company. I needed to provide BG records to document lows (Ironman training will do that) but not any hospitalization documentation (as there is none). Frustrating to hear some of the gov't mandates as to what they will/won't pay for - and think it may get worse. CGM is essential tool - end of story.
Thanks for your input! I totally share your concern and your bottom-line take on it.
I have Kaiser Permanente Northwest (Oregon and Washington state) They cover CGM for children, not adults. I pay put of pocket for mine. I do get the "Kaiser rate" through an Rx but it is worth it to me to give up some Nordies trips. Because I have to keep my bg's between 60 and 120 at all times (born with less than adequate kidney function) I do have some scary lows. I also try to extend the use of the sensor. After the 2nd week it getsw less accurate in terms of the bg number, but the trend arrows are still spot on.
Thanks for your reply! Sorry to hear about your insurance's nonsense approach. What are your tricks that allow you to prolong the sensors use? Do you use skin-tac, etc.?
Of course, I shut off the sensor wait a couple hours and start it up again. How is it gonna know? I found Hypafix tape. It works really, really well (without leaving those blackened adhesive marks). It's been in the upper 90's today in Portland and it's still on. I got Hypafix from Amazon. It comes in 2" width, 10 yards. IU cut it in half lengthwise and put a strip on each side of the sensor adhesive. I am especially impressed since it has been so ot and humkid the past couple of day. I've had to replace my infusion sets each day - they slide off in the sweat.
My insurance covers 70% of my diabetes supplies, the way it covers 70% of everything else. I have a $1000 deductible. I recently switched to this plan, and am applying for new sensors for the G4. They are asking for a printout of my BG numbers, I guess to see whether it's "medically necessary" that I continue to use a CGM (all I'm doing is switching from Seven Plus sensors to G4, and we already established that this was "medically necessary" with my last insurer). I'll write back and let you know if they turn me down.
before cgm I tested 10-15x a day. And I still do. But with my Dex4 CGM the timing of my tests hs changed. If the trend arrows are either up or dawn, I can correct, change my basal and avoid going outside of my range. It is a key component of my A1C success (between 5.1 and 5.4 for years now). I figure there is no reason that I can't have blood work that is close to that of a person without D.
I've had type 1 30+ years, diagnosed soon after retiring as a ballet dancer. Pumping for 8 years or so
My insurance covers 80% after the deductible. They just changed things this year so I am not sure about a co-pay.
Thanks, Jeff. I assume you got a CGM. Have you had any problems with approval process at first? Regards, Mark
Thanks for your reply! The best of luck with your new application and let us know how it goes. Mark
No .. it was pretty smooth. I needed a new Rx from my Endo after which it was approved within a few days. I was worried that I would run out of sensors but they told me if it gets too close they (Dex) would just ship me one. It wasn't necessary. Customer service from Dex has been very good (aside from the phone menu thing).
I have managed care medicaid. my ins do not cover the Dexcom at all but my representative managed to get my ins to cover it thankfully
I am very happy to hear that your representative was able to get Dexcom covered. Needless to say that it should not had to take such an intervention. I wonder how many out there need it, but cannot afford it. Every T1 needs it.
I use edgepark for my diabetic supplies needs. I was using neighborhood diabetes supplies but my insurance doesnt take that supplier. But Edgepark has dealt with my current insurance before with getting my animas and dexcom supplies and makes sure its covered. I hate that I have to go through hoops, red tape, etc just to keep myself safe and healthy
Edgepark is a responsible supplier in my experience. I have been using them since 2010. With all the red tape, it's good we could get CGM. Be well!
So far so good for me. They respond right away, understand I cant hear on the phone and do not mind emailing, was on top of the insurance issue I had (was on work ins and then was on medicaid as I am on unpaid medical leave and it was a mess to get it fixed) and didnt order supplies until it was fixed, etc. They got me my supplies asap so I didnt run out, etc
Erika, the best of luck with your discussion! Hopefully things have changed for the better. Let me know how it works out.
100% for all diabetic supplies. And I do know how lucky I am. They ARE an essential for T1's.