Replies to This Discussion

Permalink Reply by Hope on March 12, 2011 at 11:06am

It varies based on insurance company. I got mine while I was pregnant and they commonly approve then. If my fails, I don;t know whether I will be approved or not. Some people seem to get them without difficulty though. did your endo write a letter of medical necessity?

Permalink Reply by Gary Harrison on March 12, 2011 at 11:18am

My Dr notified my insurance company that she was putting in for CGMS for me due to the fact I have Hypo Unawarenes
I was approved for a year before she even had a chance to send it in.
Strange how some Insurances have their clients Jump thru Hoops and others just hop on board with the technology

Gary

Permalink Reply by rosieb on March 12, 2011 at 12:03pm

Hey Rebel
I'm surprised your insurance would deny the CGM. It took me a year to convince my insurance company that the units were indeed necessary to my health and when I finally got approval so did everyone else (i thought). Find out where you send a letter wanting another opinion on this matter. I did it 4 (3 to cigna, 1 to other) times and by the time it went to an outside source I was approved. Good luck with this, it can be a nuisance until they finally see the light.

Permalink Reply by Natalie ._c- on March 12, 2011 at 1:19pm

It really depends on the insurance company. And also how proactive your doc and CGM rep are. I got mine with no trouble at all, and don't really know why. But I'm really glad to have it!

Good luck, and keep on fighting!

Permalink Reply by Rick on March 12, 2011 at 3:08pm

It does vary by insurance. I was fortunate enough to switch to a carrier that covered the CGM- but, the new carrier did require the endo to write a statement that i was having lows. Of course. all of us know that highs need to be reacted to as well.

Permalink Reply by Fred Goldberg on March 13, 2011 at 7:36am

Insurance companies love to keep their costs as low as possible. If you want a CGM, then have your Endocrinologist write a letter of medical necessity. Have you never gotten a low in the middle of the night? Have you never slept too long and gotten a low? Those are two examples of hypo-unawarness almost every diabetic has. Most Endocrinologist's write a letter with no problem.

Permalink Reply by Geoffrey Steinman on March 22, 2011 at 5:13pm

the key phrase my endo put in my letter of medical necessity was "has had low blood glucose episodes which, on at least one occasion, required assistance from another individual"
now, the definition of the word "required" is up for debate... but BCBS-GA approved my application

Permalink Reply by Tobiwan on March 23, 2011 at 10:02am

Ins companies do indeed want to keep cost down, The sof-sensors needed to insert and connect to the transmitter cost close to $45 each. Medical necessity is the Key. I am very pleased with the increased control I have with my CGM.

Wish you success with your attempt to get this great device

Permalink Reply by Amy R on April 3, 2011 at 7:00am

Usually hypo unawareness is a reason to approve the cgm, but there are some insurance companies still lagging behind. Is there any chance it's the type of pump you want not being their preferred pump? Maybe you'd get coverage if you went with another brand and another cgm?
Another thing...not only is every insurance company different, but every plan is different. For example, with my insurance, all I need is a letter of medical necessity but another person with diabetes that I know has to submit blood sugar readings, wait for approval, etc.
Good luck figuring it it out. Hopefully you'll figure out the hoops so you can jump through them.