A Continuous Glucose Monitor (CGM) is a complementary device for managing type 1 or 2 diabetes. For patients with diabetes, a CGM may lessen the frequency of finger-stick tests and let them see their glucose trends conveniently. Additionally, people with poorly controlled type 2 diabetes can significantly lower their blood sugar levels with this device. But despite its usefulness, it may be challenging to acquire.
If you live paycheck to paycheck or have other financial priorities, this medical product may not fit your budget. But depending on factors such as brand and insurance, getting a CGM is still possible. Learning about the costs involved in getting a continuous monitoring device might be difficult, but it’s essential for you to understand the details so that you can minimize your expenses.
How much does a CGM cost?
Like any other diabetes product, CGM prices may vary depending on the brand and the way it works. Many insurers cover CGMs for people with diabetes, especially if you are on insulin and meet their guidelines. Without insurance, CGMs may cost more than you are able to spend, but for some people, may be worth the cost.
To lessen your out-of-pocket expenses, check with your insurance to see if they cover some of the cost.
Where can you get information about CGM insurance?
The best way to see if your insurance company covers CGM is by asking the right people. It might be hard to work your way through all the rules and terms, but reaching out to people who know the answers can give you the necessary information. Here are some ways you can get answers:
Better Health
Better Health can help you with the time-consuming task of figuring out if your insurance covers a CGM and your other diabetes supplies. A member care advisor can check for insurance coverage, and even coordinate with your doctor on your prescription – all at no cost. They can even help you select the right product, and ship it directly to you for free. Visit their website or call 415-475-8444 for assistance.
Your employer’s benefits manager
If you get your healthcare insurance through your employer, you may ask your human resources manager or a third party who acts as an internal benefits manager about their coverage for CGMs. They can give you more information about your insurance plan or point you to the right person.
Your insurance company
Most insurers also have a website where you can search for your plan. There, you can search out if they cover CGMs. Coverage details may also differ from one insurance company to another, so you might find the CGMs in a section you weren’t expecting.
For example, one insurance website may say “not covered” when you search CGMs under pharmacy benefits. But if you look more, you might find the device under the durable medical equipment (DME) benefits. Try to spend time looking at different options in your insurance researching different plans to make sure that you cover all bases.
Another way to figure out your coverage is to contact your health insurance carrier. You can look for the company’s phone number on their website or your membership card.
When you have their contact information, a good rule of thumb is to set aside 30 minutes of your time for a call with a customer service representative. They can explain the coverage of your insurance plan, which may include CGMs.
How will you know if you can get CGM insurance?
You must first ask yourself whether you are eligible before applying for CGM insurance. Most insurers provide criteria you should meet, including:
A diagnosis of type 1 diabetes
- A need to use four or more daily blood glucose monitor tests
- An insulin treatment plan that has 3 or more shots of insulin a day or an insulin pump
- A need to adjust your insulin treatment based on therapeutic CGM results
A diagnosis of type 2 diabetes
- A treatment plan of at least one or two types of insulin
- A need to check your blood sugar at least four times a day
- An insulin treatment plan that has 2 or more insulin shots a day
- An enrollment status on your insurer’s diabetes coaching program
With these qualifications in mind, your insurance company may request prior authorization. This is where your insurer evaluates the need of a CGM before agreeing to cover it for you. Better Health can coordinate directly with your insurer and save you the time and hassle of getting prior authorization.
Let Better Health help you with your CGM insurance
At Better Health, our team understands how essential CGMs are to improve your quality of life. That’s why we’re here to help you. We handle all the paperwork — from working with your insurance to getting a prescription from your doctor — for an easier, faster, and more transparent way for you to get your medical supplies and care. Get in touch with us today at 415-475-8444.
What can you do if you don’t have CGM insurance?
You can still continue with your application for CGM coverage even after your insurer initially denies it. They can reconsider your case, especially when you have a reasonable dispute. The insurance company will usually tell you why they rejected your application, which you can use as a basis for your appeal. To help make the appeal process successful, you can try the following steps.
Review your insurer’s guidelines
It’s always best to recheck your insurance company’s guidelines if you plan to file an appeal. You’d want to ensure that you fit all of their criteria and if their requirements are up to date. Sometimes, insurers deny applications based on outdated research, so you can include that when writing your claim.
Conduct research
Research materials that support your claim can make your dispute more convincing. To start, you can browse your CGM manufacturer’s website or look at other reputable sites.
Find laws about diabetes
You can look up federal or state laws about diabetes to strengthen your claim. After all, some laws talk about what your insurer can or cannot do when it comes to benefit coverage. You can use these laws to support your reason for appeal.
Talk to your doctor
You can ask your doctor to support your claim. They can write a letter confirming that you need a CGM. Better Health can handle the paperwork with your doctor and check your insurance to ensure you’re covered and never overpay. Call Better Health at 415-475-8444 today.
