DexCom 7 - The Insurance Story

So, I'm currently rocking the DexCom 7 and have been for 4 days. I love it, love it, love it. For most of the posts, I'll likely be talking about how I use it for running, but this time around, I'm going to tell the insurance story, because I wouldn't be using it if insurance didn't pay for it. Not that my health isn't worth the $140 a month the sucker would've cost me, just that... well just that I guess I didn't think it was.

To recap, this all started late last fall when I met with my Dr. and asked them if my insurance was approving CGMS, yet. Without asking me what insurance I had, the doc pretty much dismissed it, saying that with my good A1C's, it wasn't happening.

About a month later, I was talking to a co-worker who told me his wife just approved on our health insurance.

At the time, I was actually on my wife's health insurance. I'm incredibly blessed to have two wonderful insurances to choose from. The wife's is a teeny bit worse but is a bit cheaper every month (but not much: again, I AM blessed and I know it.).

But this experience told me that if I wanted to have a smooth CGM ride, I needed to get back on my own insurance.

See, the thing is this: the thing I was most scared of doing was FIGHTING with insurance over how sick I am, because I'm not the type of person who dwells on that. At all. So while I can tell you that there are times when diabetes sucks, I tend to forget about it rather quickly and I really didn't want to be in the situation where I was appealing and rehashing things with the insurance company.

But the other thing I needed to do was switch doctors, because good enough wasn't good enough for me any more and I didn't feel like I could trust my doctor to go to bat for me.

So on Jan. 1, I switched to my new insurance. If you're reading this, I live in PA and my insurance is Highmark.

Switching doctors took longer. Endocrinologists are rare it took me until the end of March to get in (I went to Hershey Medical Center). After that appointment, it took me about a month to get in to see the pump specialist (who is also the CGM specialist). That took us deep into April.

Hershey Med's policy is to have prospective CGM patients go to a meeting that's held every other month, but I caught a break by instead meeting with all the reps at a diabetes fair, which saved me some time.

By the time I met with the pump specialist, I'd decided to go on the DexCom. I did the paperwork and the pump specialist wrote the letter saying why I needed it. She focused heavily on my hypoglycemic awareness, particularly when I'm deep into exercise.

The combination of great insurance plus the right doctor equaled a quick approval at 100% coverage. In the end, it took nearly six months, but zero appeals. I got the call on Tuesday and had the DexCom on Friday. I installed it myself (I don't think I was supposed to but the directions were pretty good) and I'm loving the crap out of it. But I'll save that for the next post.

Comments

  1. congrat's. I'm very happy for you. What are the requirements for approval for your insurance? Is it case-by-case based mostly on low blood sugar episodes?

    ReplyDelete
  2. The official requirements were:

    1) 30 days of blood sugar logs
    2) Questions asked by my doctor. The key questions were about hypoglycemic unawareness, which is an easy qualification for someone who trains a lot - it's often tough to know if you're low or exhausted.
    3) Letter of necessity from dr. based on answers to questions.

    I've had no ambulance rides in the past several years and my A1C's are pretty good, too, but the hypoglycemic unawareness was the critical piece for the insurance co.

    ReplyDelete

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