Insurance coverage

Apparently my insurance cannot do math. I was just informed that they consider a box of 5 Medtronic Enlite sensors, that are approved by the FDA for only 6 days at a time, are considered a 90-day supply by my insurance. I have been able to order them without a problem every 4 to 5 weeks up until August. They won’t let me pay out-of-pocket either because they are prescription and must go through insurance.
I had a few leftover Sof-sensors from last December, but I’m down to my last of them too. Testing my BG every 2 to 4 hours is making me miss a lot of highs.
I am really frustrated!


Your doctor should be able to help you. Insurance is a pain!

I don’t understand why insurance companies change the way they do things all of the time. It makes no sense. Always making our lives harder than need be. Its so frustrating!! Like we don’t have enough to worry about in a day!

@MaggieJo, Yes. I agree with @ScottT you should see if your endo can help.

@Gina and @ScottT,
Do you think it has something to do with the way my prescription was written?
It is much easier to call my doctor’s office than to fight with insurance (wait on hold with insurance…) any day.

@maggiejo definitely! Give them a ring and ask! Let is know!!


I agree with Gina, but you could call you whomever you receive your supplies from and ask them to read the script – this way you know what to tell your DR.


What is your address again… looks like they took most of the post off …


The problem has been solved!
Here is the detailed saga, if anyone is interested:

My original order with Medtronic was for 1) a box of 5 enlite sensors and 2) 100 alcohol swabs. After 2.5 weeks with the status as “insurance pending,” I spoke to someone at Medtronic who told me: - I could only have “1 sensor” and - I had ordered IV prep wipes a month earlier, which was considered a 90-day supply so I could not have alcohol swabs. I had her cancel the order for the swabs (I was only ordering them through Medtronic so I didn’t have to make a trip to the pharmacy). And I made her triple check the sensor coverage. After a few minutes on hold, I was told I could have “3 sensors.” I told her this was unusual, I had been getting a box of 5 each month until now. After going back and forth, explaining the math (5 sensors at 6 days each…) she told me I’d have to take it up with my insurance and she would ship me the “3 sensors” in the meantime.

So, I called my endo to make sure my prescription or consent or whatever it might be, had not changed or been miswritten. They had no clue what I was talking about. I told them they would have received some sort of form for the doctor to sign back in December when I got my new pump and sensors. They still had no idea what “prescription” or “drug” or “pharmacy” I was referring to (but we kept going around in circles talking about it for 10 minutes).

Then I called insurance and first spoke to a medical coverage rep. She was very patient with me and tried several variations of CGM, Glucose monitor or enlite sensors. Eventually she realized I should speak to a prescriptions representative and transferred me to one of the least helpful reps I have ever spoken to. She insisted that I give her an exact drug name and would not listen to what I was saying about sensors being a diabetic supply, not a drug or prescription. I eventually hung up on her.

I received my Medtronic shipment and opened it up: 3 boxes inside. Sometimes the Enlite sensors come 1 in 1 box and that’s what I assumed I had. Open up the box: 5 sensors inside! The whole problem was poor communication with the first Medtronic rep and the delay was caused by the alcohol swabs in the order! I’m set for 3 months now! LMAO.


What a bunch of morons. I would post this same information on med Tronic’s Facebook page if you have Facebook.

They have another level of customer representatives who will call you and reach out to you.

It’s become so complicated with insurance that it’s not fun anymore with prescriptions and such.

My local pharmacy has been denying me to use any coupons to reduce my co-pay as they stated that the coupons could not be used for state employees which I’ve been using the same coupons for the past two years.

I really don’t know what’s going on but it’s very frustrating.

I’m glad you got your sensors and it sounds like you’re all hooked up to go. Just go to the dollar store and buy a bottle of alcohol and some cotton swabs!

Ok I am emotionally and mentally distraught. I have been fighting with BCBS for 5 weeks now to get them to cover the CGM. My daughter is 11 years old and the MD has tried to get her to agree to one for over a year due to her blood sugar swings being so severe. Finally she agreed to it and now 5 weeks later the insurance company is still denying it. They are saying that she has to have repetitive hypoglycemia. I counted 21 low BG’s in the last month plus she has had 5 hypoglycemic seizures in the last month. All the while becoming more and more unaware of her hypo symptoms. I found out today that the insurance company does not consider the BG low until it is under 50. That is crazy because medical definition of hypoglycemia is <70. Did anyone else out there have this kind of trouble? And if so what did you do?

Yes, the problem here is that your endo has to submit paperwork to the amazing (joke) insurance companies in the U.S. of A as durable medical equipment (DME) and that it is “Medically Necessary” otherwise most insurance will deny it and the merry-go-round cycle starts… Hope that helps anyone out there.