Which insurance covered your CGM

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Permalink Reply by Heidi Bruggink on August 6, 2009 at 12:09pm

Empire BCBS of New York covers my CGM and sensors 100%... but I know that my employer has a very high-level plan within Empire. I think a lot of it depends on the particular plan, though once a company starts to routinely cover CGM (thanks, JDRF study!!) it's a lot easier.

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Permalink Reply by Toni Crebbin on August 6, 2009 at 12:21pm

After being denied 1.5 years ago, I am happy to say that RegenceBlueShield is covering my new Dexcom Seven! They are covering the receiver and the sensors at 90%, and will give me two months supply at a time. I did not have to file any appeals or anything!

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Permalink Reply by Mark Hagen on August 6, 2009 at 1:13pm

Premara Blue Cross of Seattle is covering mine, after an appeal by myself and the doc/CDE. Without the help of my CDE it wouldn't have happened so quickly. They put me on the iPro and we could show that my control is normally pretty good, but I do have occasional lows, completely unnoticed by me. I also had to show that I was a danger to others while low. As I have driven and become low while driving that wasn't a problem. I check before driving but on long trips it is still a problem. Interesting that being a danger to myself wasn't a good enough reason.

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Permalink Reply by Jim Devlin on August 6, 2009 at 5:39pm

It might not be such a good idea for any of us to mention any driving lows to anyone. I know this from a personal experience.

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Permalink Reply by Helmut on August 6, 2009 at 6:54pm

Aetna CT. Never even contacted them. Faxed the paperwork to Dexcom and the starter kit came in the mail a week later.

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Permalink Reply by Tom Goffe on August 20, 2009 at 9:15am

Anybody have luck getting coverages for CGM from the Department of Veterans Affairs (VA)???

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Permalink Reply by MelissaBL on August 30, 2009 at 8:32am

I just enrolled in BCBS Texas, which denied a lot of people in the last three years. But I found (by going to their site for providers only) the medical policy that proves they will cover it. Those who've been denied by BCBS of Texas, go there. It was updated in April of 2009.

Those who are still facing denials, what you want to find is your insurer's 'medical policy' for DME coverage of continuous glucose monitoring (interstitial). Search your insurer's websites for this. 'Medical policies' are long, technical documents, but often they list the cases in which they will approve long-term use and you can use this to arm yourself with the glucose records you need to gain approval. Just googling 'blue cross blue shield medical policy glucose' brought up hundreds of different plans and their stipulations for approval.

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Permalink Reply by faye on September 1, 2009 at 10:32am

keystone health plan east in pennsylvania covered my dexcom. after i meet a $100 deductible, they cover 90% of durable medical equipment. i believe i met the deductible paying the 10% of the receiver cost.

keystone approved me with no resistance whatsoever, although i had to go through a vendor rather than directly to dexcom. the vendor required a whole other set of paperwork and the sensors were on backorder, so getting my starter kit took a month.

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Permalink Reply by Fran Pomerantz on October 23, 2009 at 1:01pm

We were just approved by Blue Cross Blue Shield of Vermont yesterday after multiple appeals! YEAH!!!

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Permalink Reply by Sami on November 12, 2009 at 8:44am

Blue Cross Blue Shield of Missouri - I now have Healthlink Open Access and they cover my supplies.

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Permalink Reply by Mommy and the monkeys on November 12, 2009 at 12:23pm

just switched to Highmark BCBS - they also cover my CGMS

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Permalink Reply by Stephen Woodward on November 12, 2009 at 12:37pm

Kaiser Northern California...after a lot of pushing from me. As a T1D w/o complications, emergency visits and an A1c of 6, it was a real challenge. Because I do not meet their criteria for getting a CGM. I kept at them with the stories about my daily challegenges with hypo unawareness and the impact it had in my daily life. It has been about two and a half months. What a different world emotionally and physically. I'm glad I faught for it, it was well worth the effort, frustration and depression.

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