How likely am I to get insurance coverage for a continuous glucose monitor?

Advertisement
Advertisement
William Lee Dubois
Endocrinology Diabetes & Metabolism
Nationwide, approval for CGM monitor for diabetes is still a bit patchy, with a dizzying array of requirements to get covered. Generally speaking, type-1s have an easier time getting covered than type-2s, especially if they are hypo unaware, have had more than three documented readings at or below 50 mg/dL in a month, and more especially if they’ve had an Emergency Room visit.

In theory, all it takes for approval of a CGM monitor is a signature on a form called a “Letter of Medical Necessity,” which also doubles as a prescription. Each CGM company has fill-in-the-blank letters for your doc on its website. In reality, it’s quite a bit more difficult. The insurance company will probably want to see your doc’s notes from the last two visits, recent lab work, and 30 days or more of fingerstick meter data.

It’s common to be rejected on the first round but approved on appeal.The insurance company has nothing to lose by trying to say “no.”  Don’t let their game get your blood pressure up, but be persistent.

Once covered, your CGM will be paid for by your health insurance under what’s called the Durable Medical Equipment, or DME, portion of your policy. Overall costs will depend on your coverage.
Beyond Fingersticks: The art of control with continuous glucose monitoring

More About this Book

Beyond Fingersticks: The art of control with continuous glucose monitoring

Everything you ever wanted to know about CGM (but didn’t know to ask)!Continuous Glucose Monitoring (CGM), the revolutionary technology that’s poised to completely change diabetes care, gives you...

Continue Learning about Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes ...

is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.
More

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.