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Questions about CGM

Discussion in 'Adults with Type 1' started by LillyCat, Jun 26, 2012.

  1. LillyCat

    LillyCat New Member

    Joined:
    Jun 26, 2012
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    1
    I recently had to switch insurance companies and am hoping someone here has some experience w/ getting insurance to cover a CGM. I currently use a Minimed pump (paid for by old ins. co.) and have no preference between the Minimed CGM and Dexcom.

    My current insurance is BCBS through the Texas High Risk Pool, w/ a $5000 deductible and $200 Rx deductible. Does anyone know the likelihood of getting them to approve a CGM? I know every insurance is different, but the number of type 1's covered by this policy in Texas is fairly substantial. I hope someone here has had experience with them and CGMs. I have paperwork started w/ both Minimed and Dexcom, but I don't want to get my hopes up.

    My blood sugars have been terribly labile the last few months. I'm only approved for 6 strips/day and even w/ a pump, I'm just not controlling my sugars well enough. I can't feel highs at all, and don't feel lows when I'm asleep :(

    Thank you to anyone who can offer any info!!!
     
  2. MomofSweetOne

    MomofSweetOne Approved members

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    Aug 28, 2011
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    2,747
    We have the Medtronic CGM, and getting it approved through BCBS PPO in our state wasn't a problem at all. It took about two weeks and a letter from our doctor stating that our daughter has nocturnal hypoglycemic unawareness. Good luck!
     
  3. MAS

    MAS New Member

    Joined:
    Oct 14, 2012
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    To Lilly Cat re: Ins

    Lilly Cat,
    I can no longer afford any insurance. I'm basically dirt poor. But I scraped together some funds and just bought the Dexcom. OMG. It's a life changer. I basically pleaded my case to the Dexcom rep and they 'gave' me 2 extra sensors (about $75 each). This device is such a game changer for me that no matter what I have to do, I will afford this device. I stopped my cable, sold my sports equipment and have just been making plans to raise that money any way I can. I figure, for each time the Dexcom wakes me up at night (preventing a devastatingly low BS, I save $150 on an EMS visit. In the past, I've called the actual product providers (Humilog, Lantus, Bayer), told them I had been buying their products for the past 35 years and told them I no longer have insurance. They asked me to send in my tax return and said I qualified to receive their product at no charge (for now). Get a CGM any way you can. It's a life changer!
     
  4. Christa1971

    Christa1971 New Member

    Joined:
    Jul 4, 2013
    Messages:
    1
    Dexcom

    My parents bought my Dexcom, as my insurance stinks. I have mixed feelings about it. Failures in water, seizures when I am watching it too closely. . . Sometimes it's better to just use my pump.
     
  5. solobaricsrock

    solobaricsrock Approved members

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    Sep 21, 2013
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    I work insurance claims on the Medtronic side. First the insurance has to be verified to confirm benefits. Its hard to say until that step is completed. Your guess is as good as our until that happens. 2nd step is to determine which system you want (I've used both MDT and Dex for a while so I have experience with both) The reason for that, is because if you hit the insurance with both requests, it stands a chance they will deny coverage for both. After that Dex or MDT will call you and explain your coverage so you can make a formal decision.
     
  6. MomofSweetOne

    MomofSweetOne Approved members

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    Just curious: If you work for Medtronic, how do you get away wearing a Dexcom G4? My daughter feels sorry for our Medtronic rep because he told her he's expected to use even the lancet from Medtronic's chosen devices. There's no way she'd chose that over her Multiclix.
     
  7. solobaricsrock

    solobaricsrock Approved members

    Joined:
    Sep 21, 2013
    Messages:
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    I get away with it because I can. Of course the prefer I wear their product, but the conversation I had with my boss was straight forward. I told her that the Dex sensors are better in most respects, and when it comes to my health I will not accept 2nd best. What could she say? So really they cant say anything. And of the type 1's I work with, most use a Dex system with MDT pumps.
     

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