The path to a CGM narrows

Well, I sat down a couple of weeks ago a completed the paperwork for a Dexcom continuous glucose monitor (cgm), I waited to make sure I had the 60 days of Bg test results (I was under the impression that was needed for the insurance to approve me). The last thing I wanted to happen was to be missing something on my end. I happily provided them with the family history and personal information, the insurance information and all of the necessary contact phone numbers and emails. I did have a few questions so I called the contact number on the form and left a message. Later that day I got a call from a cheery young man who made me feel like this was going to be a slam dunk with my insurance. Wow, this is going to be easy and they are going to do all of the work for me, yippee!

Now, knowing what I know about medical reps, I should have held on to my enthusiasm. We lived for a time in a neighborhood filled with young adults employed by various drug manufacturers, medical equipment suppliers, and medical supply representatives. They work really hard at being the pulled together face of the company. That means energetic, well-dressed, pulled-together young business professionals. Many of them were, like us at the time, newlyweds, buying their first home, and starting families. The problem we had was that they didn’t really work much. They actually only work during the times they could get in to see their clients, the doctors. That was usually over the mid-day break they take do the stuff that’s done when there are no patients in the office–you get my point. We would come home after a full day at work to find our medical industry neighbors well into their after dinner cocktails, the yard is mowed, the car is washed, all the errands are run . . . what’s left but to sit back and relax. Yes, the Dexcom rep was very nice, answered all my questions, and filled me with hope about this gadget that was going to be the ‘cat’s meow.’

They did what I can only assume it “their part,” then emailed me that the insurance processing would take place with a company named Pumps It. About a week went by and I received an email from the folks as Pumps It, their email just said they needed to go over my insurance. Let me say the folks with Pumps It are very kind people, but unfortunately they had to deliver the bad news that it turns out my insurance will only cover any out of pocket expenses after the $2500 deductible is met. OK, I had seen some amounts for the cost of the monitors so I braced myself. I think she was speaking in slow motion, or I was going into shock–sticker shock that is. Here’s how it breaks down:

$1000 Dexcom equipment CGM, $350 every 4 weeks for sensors (that’s if each one lasts a full 7 days and doesn’t fail for some reason). Now, to cap it all off our insurance renews in February. That usually means a completely new insurance company with a whole different set of rules, eligibility’s, and nonsense. That being the case they might end up covering about $300 before our new insurance year begins.

I’m going to have to wait for the next insurance round in February. At this point a CGM seems like a luxury that I can’t afford. For now I’ll keep regularly monitoring, and hope for some real health care reform.


I wish I oculd give you some encouragement. I cannot give much. These high deductible policies are so punishing that it makes many treatments really out of reach. I do want to let you know about one thing if you are working. Chances are your employer offers a section 125 plan. If so look into using it next year for the these costs. In most cases, it reduces the overall cost by 15 -25% depending on your federal tax percentage. The good part, is that even if you do not obtain these items you have to figure that other medical expenses will add up. As we get into the fall it is important to look into the section 125 program so you can set up deductions for next year.

It will not solve all the problems, but it will reduce the cost of getting these items and otehr medical treatments a little less expensive.

rick phillips

Thanks Rick, I’m self employed and my husband is looking at becoming self employed soon. We are trying to determine insurance options now.