Buying a Continuous Glucose Monitor (CGM): The Insurance Application

Patient Expert

One of the hardest things about diabetes is figuring out your optimal management system. Pump vs. pens, fingersticks, or a continuous glucose monitor (CGM). Many times, though, choices are dictated by what your insurance says you can do.

To complicate matters, insurers limit the number of strips you can use in a day. Regardless of the type of diabetes you have, doctors and patients know that preventive measures like tight blood sugar will prevent complications and, depending on your A1c, it may be more advantageous to have a CGM to reach your diabetes management goals.

There are three continuous glucose monitors on the market right now: Minimed Guardian Real Time CGM , the Freestyle Navigator , and the Dexcom .

For people who really struggle to figure out their diabetes trends, it is worth talking to your doc about Medtronic's iPro . It is strictly for use in a doctor's office. They place a sensor on your body and you wear it for three days or longer. Patients do not see the data, which is disappointing, but I must admit the sensor is small and easy to attach After three days, I returned to the office and they removed the sensor and downloaded the data. The information from the data was fantastic for making the right adjustments. Ask your doctor about trying the iPro!

After looking at my iPro results and talking with my CDE, I felt that it would be worth it for me to invest in a CGM to follow these crazy cyclical patterns and see if I can change them for the long term. I think after a few months of watching trends with a CGM, I will hit the goal of 6.5 A1c and see more flatline in my blood glucose. While my CDE, Judy, wears the Navigator, she suggested that I look at Dexcom for myself. One reason is that Dexcom is solely focused on continuous glucose technology (Dexcom is partnered with Animas and JDRF to produce the CGM for the Artificial Pancreas ).

The cost of a Dexcom kit, which includes the receiver, transmitter, cable for download and box of sensors, is $1,274, plus $15 for shipping and state tax, so for the state of VA the total cost would be $1,353.45. Additionally, a month supply of sensors is $275.00. (By the way, if you are interested in making the investment now, there is a Dexcom promotion going on until the end of March 2010. The entire start up kit is $999.00, plus shipping and taxes.)

The process of applying for insurance coverage is detailed, hence the reason for the two month process I'm in! First, you need to fill out the form for Assignment of Benefits and the Authorization for Release of Information. This allows the Dexcom rep to work with your doctor to develop a case for need and to study your insurance requirements.

Since each insurer within each state has their own requirements, you need to provide blood glucose logs and other documentation showing that you are following ADA best practices guidelines. I cannot suggest strongly enough that you work with sales reps to help guide you thru the process.

For people on Medicare and Medicaid, it seems that a CGM request is always denied, but there are cash programs that may be available to you and so you should call the cgm company of your choice and ask about a program. And, if you are interested in trying a cgm without buying it, ask your doctor about the option of access to a Medtronic iPro to help to determine your trends.

I'll keep you posted on my journey in buying a continuous glucose monitor...

Read the whole series!

My New Dexcom
My Dexcom Learning Curve