GCM not covered by insurance eff Jan 2016

hello
My name is Maria and I was diagnosed with T1D 21 years ago. I have been on pump therapy for about 15 years
this year my doctor suggested I try a GCM .My A1C level went from 7.8 to 6.9 .I was so happy !!! so was my doctor and nurse
Well I received a letter from Medica saying that they had been covering the GCM in error because Medicare does not cover GCM and therefore they ( Medica do not have to cover it )
The GCM gave me so much understanding as to how my body reacts to different foods ,trends that my body has at different hours of the day or night .I was able to adjust the pump to increase the basal before that high at midnight and again early morning .I slept so much better knowing the alert would go off if I was at 80 and going down .On receiving the letter I called Dexcom the maker of my CGM and found out it would be 240 dollars a month for the sensors and 600 twice a year for the receiver
I am retired and cannot afford it . I wish our goverment would realize how helpful this tool is for someone that lives with T1D

If you haven’t done it already, you can file an Appeal with Medica. All Medicare Enrollees are entitled to a formal Appeal. There are some major insurance companies providing Medicare Advantage plans that are covering CGM’s. Reference the following website for how to Appeal your denial and also some financial assistance information: http://integrateddiabetes.com/cgm-insurance-coverage/

From that website:
"People with Type-1 (insulin-dependent) diabetes often qualify for insurance coverage, particularly if the following criteria are met:
•A history of hypoglycemia, documented in the physician’s chart/records
•Presence of hypoglycemia unawareness (lack of symptoms during the early phases of hypoglycemia)
•Erratic blood glucose levels
•Suboptimal HbA1c
•Frequent blood glucose monitoring
•Having completed diabetes self-management education"
Use those criteria in your Appeal, and make sure your Physician uses them also.

mlecuona,

I’m also on Medicare and retired with limited income as well. I wear my CGM (Dexcom G5) 24/7 and have done so for over five years. I wore the Navigator CGM for a couple of years before that. While I was on my wife’s insurance (before I went on Medicare) the CGM was covered and short of co-pays and the like my cost was tolerable. Now that I’m on Medicare it is not covered by insurance and I’m on the “cash plan” with Dexcom. Depending upon how many sensors I purchase over the course of a time frame the cost for the replacement transmitter(s) is either $199 or can also be no charge.

Talk with Dexcom and have them explain (what I call the “cash plan”) options for you while on Medicare.

Susanlily

This is interesting and valuable information.

I just changed my supplemental coverage from AARP/UHC to Manhattan Life. I went from a Plan F to Plan G as it will save me a huge amount in premiums over the course of a year and it offers the exact same coverage except that I have to pay a one-time annual deductible of ~$160 each year. The AARP/UHC plans are quite pricey and it may be due to overhead charges from the AARP affiliation.

I’m going to review the information you have provided and see about gearing up for a claim that would have to go to Medicare and the Part B / CME route first and then to the supplemental.

Can’t hurt to try.

I was diagnosed T1D in September/1967 and have worn insulin pumps for over 25 years and CGM devices now for approaching 7 years. Dexcom is shipping the new G5 this week as my G4 transmitter is just about ready to ‘time out’. I wear my CGM 24/7 and simply cannot operate well without it as I just can’t sense the low BGs anymore. One of the hiccups with T1D when one has had it as long as I have. Sucks … but it is what it is.

I’m assuming that any supplemental would pick up their balance of coverage once Medicare approves any CGM coverage. Do you have any discreet data with respect to Manhattan Life Insurance out of Houston, TX that administers the Plan G supplemental that is written by Medicare?