continous glucose monitoring supplies
I am just joining but I have an urgent need for information. My son was diagnosed with Type 1 diabetes when he was 3years 6 months old 23 years ago. I won't bore you with the details of the challenges, changes and triumphs we have faced in those years. I am so proud to say that now at age 27 he is in his third year of medical school. He has a wonderful wife who is helping him face the challenges of diabetes every day and night. Honestly medical school is an unbelievable grueling task. Then add to it diabetes and it is nearly impossible. Now I know why we have so few diabetic doctors! Anyway he wears the CGM system and his insurance (provided by the medical school !) has of course denied coverage for the supplies. This monitoring system is essential to his health, studies and success. So how do we go about getting these sets? at a reasonable cost? from Canada? Please help me catch up, be informed about your experience, what you have tried and been successful with, unsuccessful attempts, whatever? I have advocated for him so many times before with health care providers, insurance people, schools, coaches etc. But I do feel like I am joining this match rather late in the game. Your experience and expertise is greatly appreciated. Mary Ellen
also Jordan's MOM
also Jordan's MOM
Replies to This Discussion
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Permalink Reply by Dave on -
Hello, and welcome. When you say CGMS supplies what are you referring to? I wear CGMS and the only other supply that I use that insurance does not cover is the IV-3000 clear patch that I use to cover my transmitter. It is a box of sixty sheets and it lasts almost a year, other than that there are sensors and the transmitter, nothing else.
Let us know and I am sure someone here has an answer--Dave
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Permalink Reply by Mary Ellen Edwards on -
I am talking about the sensors that are inserted into the body. Jordan says they cost about $75 each. I am waiting to get more detailed information from him. Thanks for your reply. Mary Ellen
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Permalink Reply by halfnelson on -
I had to get a letter from my doctor that said I would die in my sleep if I didn't have the continuous monitor. Even so my insurance classifies the sensors as 'durable medical goods' so I have to pay a $150 copay each time I get them (no matter how many I get so I max it out) instead of the regular $30 copay for a 90 day supply like I pay for everything else. Also, they say to change those things every 3 days but mine will last a week, so my 90 day supply lasts 180 days.
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Permalink Reply by David on
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You can always appeal the decision from the insurance company. There are numerous medical supply companies, and you can always price shop.
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Permalink Reply by Jan on
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There are some insurance companies that will cover the cgms, if you go through a case manager, fill out the proper paperwork, keep records and fit their criteria. (Persistent Lows, hypoglycemic unawareness, visits to the ER, etc.) I am sure most diabetics of more than a few years standing fit the criteria, so I don't understand why the insurance companies deny coverage. Firstly, if his wife or he is job hunting, they should try, if feasible, to get a job that has insurance that offers coverage of cgms. United Health insurance immediately comes to mind; there are others. Then go on the internet and download studies showing why cgms is necessary, keep detailed written records of blood sugars and download the meter and save the info. Document and save any visits to the ER and work with his case manager to get coverage. We had to go through an appeal, but we did get coverage for cgms. If paying $75 out of pocket (Dexcom?) look up info on how to restart the sensors. A lot of people get more than seven days out of each sensor, many two weeks, possibly more. Restarting the sensors should save money.
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