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I see many people on TuD mention they use a CGM. However, I've been reluctant to even pursue it because a co-worker who has been T1 for 30+ years has one, but she told me our insurer refused to cover it so she pays out-of-pocket. I'm just curious how many of you using a CGM have it paid for by insurance. For those who do, was it difficult to get approval? Did you have a specific reason that helped, such as hypo-unawareness? I've finally made the decision to start the process with DexCom to see if I can get insurance approval, so any tips would be much appreciated.
If you end up paying for it yourself, you don't have to use it all the time. You can use it
1. To fine tune your basal doses, carb factors and insulin sensitivities.
2. When you are sick.
3. When you are on vacation.
4. To trouble shoot meals that cause very high BGs.
5. Track your Dawn Phenomenon.
Good luck with your insurance. I envy people in the US that have access to the DexCom. It's rated very highly by almost all the people using it.
I don't have a CGM, but as soon as the Vibe comes out I will be getting it. I'm not expecting mine to be covered, most Canadians I've spoken with have to pay for theirs themselves. I've only met one person who had hers covered. My endocrinologist recommended that when I get it, I use a CGM similar to above, just to troubleshot and fine-tune rather than all the time.
My insurance covered it, but I do think I had to submit a few weeks worth of blood sugar logs. Additionally, I think it helped that I was becoming somewhat hypo-unaware and that I also was planning on getting pregnant. They approved it pretty easily and cover it at 80/20 (they pay 80, I pay 20). Good luck! I hope you are able to get approval!
With me, I told the doc I wanted it (was working towards 1/2 marathon...), she told Medtronic and they did all the work. I had to do a log to get the pump but the CGM, they just did my pump log so it was very seamless. I dunno if the marathon actually mattered. I always have had enough "hypos" in my charts to "count" but I have symptoms and probably 90+% of them are "drift" hypos in the 60s and, to me, not that big of a deal.
We had no problems with insurance (my daughter was 12 at the time), but the endo did have to supply 3 months worth of logs. It wasn't a problem because we have to supply written logs at every endo visit. There was a holdup because of faxing issues between the endo's office & Dexcom, but we still had it in hand within 3 weeks.
If insurance denies, you can always appeal.
It's been a few years since I have mine so, I'm not sure if the requirements changed with my insurance. But, from what I remember I needed a letter of medical necessity from my doctor, a log of BG's, hypo-unawareness and T1. I was denied the first time but, that was only because of a coding error. Medtronic's did all of the paper work and in no time I had my CGM.
My insurance covered mine in total and required no logs or anything. I was actually kind of surprised because I'd heard it was difficult to get coverage. I'm not hypo-unaware, but I do get a lot of lows. so I was prepared to have to prove my need for it. In the end, I told my CDE I wanted it, she was unsure if I'd get coverage but said they'd start the paperwork, and insurance said, no problem, you've met your deductible, CDE says you need it, you can have it.
I am lucky that I worked for the government my last 8 years and have Medicare as primary and fed based insurance as supplement. Therefore, my cgm was paid for in full by my secondary insurance. Medicare does not pay for cgm ever. I pay double insurance premiums (Medicare and BCBS) so I do not have copay. I pay the equivalent and more though, through premiums. But in return, all my med supplies and pump and cgm are paid for. I do use the cgm all the time but could see using it 'as needed' if necessary.
PS. I do have several oral meds and I do have copay for them. $75 for brand names (90 days), which is what I mostly have.
Mine is covered 100% by insurance with no copay or deductible. I have hypounawareness and that was pretty much all they needed to cover it. I did not have to supply blood glucose logs or anything. But as others have said, just because you have a CGM it doesn't mean you have to use it every single day. I choose to because I find the information helpful especially when I exercise, but I got a shipment of 12 sensors in February and I still have 6 of them left. They will probably expire before I actually get a chance to finish them.