What, if any, health insurance companies cover CGM sensors?
Horizon BCBS of NJ (I know it’s not much help), I have a policy through work and it covers CGM with a Endo letter of necessity.
Sometimes you have to fight/appeal your insurance company to get them to cover CGM, good luck.
Before Medicare my husband and I had Aetna & they covered the CGM & supplies but they did have to communicate with my diabetologist.
Currently I have Cigna. They have to reapprove every three months for sensors and transmitter. But they have never given any issues with it. When I had United Healthcare they were also really good about it and covered my upgrade.
I have Anthem and they pay 100% for all of my CGM supplies. They allow me to get a 2 months supply every month, so I don’t have to order them as often. They are covered under the drug/prescription part of my plan, which is why they are covered 100%. If the CGM was considered durable medical equipment, like my insulin pump supplies, I would have to pay 10%. I know that I am really lucky. Good luck with getting your CGM covered.
@Joe - If you don’t mind, could you give us the dollar amount of the copay for your CGM supplies? I’m considering getting one, perhaps the dexcom new one. Cost is an issue. I’m wondering how much it will cost. I know all insurances are different. I have a pretty good one through work which is pretty much of an 80/20 plan. Just looking ball park.
If you don’t want to share the info, I understand.
i don’t mind @DDrumminMan, but it may not be comparable. I work for a company that went on a very public “we care about diabetes” promotion. So, ever since, they cover any and all diabetes medicine/management for all employees at $20 for 3 months supply. This covers sensors, insulin, test strips, syringes, pump infusion sets, pump reservoirs, etc. non-diabetes Non-promotional copays are $20 generic, $60 non-generic for which there are no generic substitutes, and the difference between the retail val and $20 (which could be quite large) for non-generic for which a generic is available for 3 months supply.
hope it helps!
CGM sensors should be covered by any health plan. I’ve had 6 different insurers since I started using CGMS technology and all have covered them. Make sure you are filing the claim under your DME (durable medical equipment) coverage and not your pharmacy coverage. Be very specific when you call your insurance company for DME providers. They will automatically go to the list for ostomy, oxygen, and hospital bed suppliers, but you need a list of diabetic supply, namely pump and CGM, suppliers, like the company Byram Health Care. Under DME, once your deductible is met, your supplies are covered at 100%.
And by the way - glucose strips are considered DME (no more pesky copays)!! Get the word out!
To your good health,
Nancy