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How did you get approved for a CGM? I am wanting a CGM as soon as I start basal insulin (on bolus only right now) I am even willing to pay out of pocket if my insurance will not approve. Anyone know the cost of it out of pocket and then for the monthly supplies?

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I have also been looking into the Dexcom for my son. Endo wants us to wait until its intergated with the Omnipod he's been using for 8 months now (We love it), not sure yet about our coverage. Started the BS log forms twice now, and sat on them because I was unsure. He's only had a handful of <50 (dx 12/09) because he is very aware of going low, that shouldn't be a strike. I am ready to get more information, though fortunately he would have to wear it. We need to troubleshoot his morning blood sugars pre and post meal. Dawn Phenomenom sometimes/ high after always. We made some changes, but a CGM would so helpful. Plus he will be driving in a year or so, nobody like to do all those checks. I think you should get it approved because you are home alone with the kids, for that alone! Ive used lil mama for a screenname before too. Lots of Luck.
I would say go for the cgm, the more tools the better!!
I think my MM CGM was around $1000 and the sensors are about $30 each. My insurance pays. I did not have to prove hypos but I was pregnant when I got it.
According to my endo., being type 1 automatically qualifies you for CGM under BlueCross/BlueShield (my insurance). I didn't have any problems with them covering the CGM.

My sensors, without insurance, are $42 each and last 3 days; so $420 a month. The CGM is integrated into my pump, so I don't know the cost of it separately, but the pump + CGM was just north of $7K, paid by the insurance company. My out of pocket was about $200.

(I have the Medtronic Paradigm 523 with CGM).
Thats good to know, I have BCBS as well.I'm assuming the doctors label type 1.5 as simply type 1 for insurance purposes..right?
I think that since "officially" there is no type 1.5, LADA all gets lumped in with Type 1.

I think before you can ask your insurance to pay for it, you need a doctor/endo to say you need it. My process went like this:

  • Told the endocrinologist that I was ready for a pump with CGM. The doctor's office contacted Medtronic to get things started.
  • Medtronic contacted me for information to submit to the insurance company.
  • Once it was approved by insurance, Medtronic called me with an estimate of what was covered.  After I agreed they shipped me the goods. They billed the insurance and whatever they didn't cover came to me as a bill about 2 months later.
I don't know what health insurance you have but the rep from MM said they are usually approved for type 1 diabetics. I have Blue Cross a she said they are good about it. I am getting a new pump and decided to get a CGM too and I will probably wear it at night mostly. She also said I can upgrade when/if a new model comes out. Good luck




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