Hi I am new to this group and really happy I found it! I am a 62 YO Male with Insulin-Dependent Type 2 Diabetes. I live in Long Island NY and I am on Fidelis Managed Care Medicaid Insurance. I have been using the Dexcom G6 for approx. 2.5 years as it was covered by my insurance because my Endo Doc wrote a letter of medical necessity. I have found it tremendously beneficial and have considered it to have saved my life on several occasions as my sugar has gone very low and very high! I have been due to re-up my sensors and unfortunately, my insurance is now currently denying covering me anymore. They have now declined me and my doctors note twice and their only reason is because they say that they don’t cover type 2 diabetics only type 1. As I am on Gov’t assistance Insurance program Dexcom’s only current program is their Covid19 program and only helps those with private Insurance. The cost price is extremely high for sensors and transmitters and DOES ANYONE HAVE ANY THOUGHTS OR CONTACTS AS TO ASSISTANCE OR HELP WITH GETTING MORE OF THESE SUPPLIES? I am truly at a loss and am all out of options on my end! Thank-you for any help or guidance it is truly appreciated. I have 6 days left on my current sensor and I am done.
Hugh W- NY
It is unfortunate that all states Medicaid programs dont cover this , some cover both type 1 and 2 , some only one, and some none (this map is from 2019 so some may have changed)
I do hope one of our memebrs can help find a solution for you
Thank-you. Yes it is true and quite unfortunate as it really has been quite helpful to me. I don’t quite understand the difference between a Type 1 and type 2 insulin dependent. Other than a way for insurance to say we don’t need to cover this!
it is rather unfair that type 2 is so often discriminated against with coverage , they should be happy to cover cgm because it helps prevent further health cost down the line
Welcome @HughW2, sorry they denied you after the last couple of years. Totally understand how valuable this tool is and should be made available to anyone using insulin because it results in much better control.
1 - Look and see if you can get the Libre sensors for a more affordable cost, since something (libre) is better than nothing.
2- Document the increase in your A1C once you are forced to quit using the Dexcom and appeal their stupid decision. I know this totally sucks, but in the beginning we had to fight really hard to get our commercial insurance HMO to cover Dexcom and it was a painful journey, but totally worth it when we were able to to finally get covered.
3 - Look on Facebook for the people that replace batteries in the transmitters and then you only have to buy the sensors.
Again, sorry you are having to go through this, totally stupid.
Can you ask them to provide plan documentation that describes coverage for cgms?
Ok Chris- Do the replaced batteries work well and reliably to your knowledge?
Hmm not sure what that test is… nor did they allude to the fact that with it they would cover me since again, I’m a Type 2 and they say they don’t cover that. Very frustrating! I will look into this test.
Sorry, my mistake, meant to say cgm.
But I did find documentation that only specifes Type 1, and evaluating whether to modify.
Thanks MM2 I realize that you meant CGM! That is very interesting on the Document you provided. The sad part is there really is no date on that document. So who knows what it takes for them to truly analize and how long to make a decision. On the bottom of that document it does say revised July of 2018. So what that means it they have had that info for over 3 years. So I am not holding out much hope that their decision will change anytime soon. I guess I should be happy that I had 2.5 years to see and have a Rolls Royce that really helped me in my care and learning that while sleeping at night my sugar really spikes, etc… when having dinner at 6-8pm at night. And now I wil have to go back to the stone and chisel of finger pricks that only takes a certain snapshot in time… needless to say I will be much less proactive during my hypo and hyper episodes. I guess the fact that I got my A1c down to 6.4 several months ago does not matter to them. I am just feeling like I am lost now and that no one truly cares about my health. NY state the Gov’t , etc… and that they are not even listening to my doctors letter of medical necessity specifically for my case. I was hoping that someone out here might know of a group, organiztion, etc… that could step-in or help. I have been in the special events industry and my small business has been decimated by the pandemic- so financially I am just totally tapped out. If I could afford the crazy high prices of the device on my own, I would just purchase it at this point. However, there is no-way I could afford the $300.00 plus dollar a month it takes to truly protect my life and have full knowledge of what is going on with my blood Sugar, it’s highs and lows! Thanks for all your feed-back! Hugh
Thanks, Chris- happy to be here. There needs to be more strides made in the coverage of Diabetes and health in the Country and I truly believe it should be universal. The problem is just getting worse over the years. I am glad there is a group of like-minded individuals who Help by guiding and informing each other of what has worked for them. Thanks for being a major part of the solution! Hugh
Copy below and paste to browser and open first link.
Members who are currently using CGM or a disposable insulin pump covered under the PDSP will be allowed to continue.
Not sure if it applies to your situation.
We have some anecdotal reports that they work, but we never did this ourselves since my son was mostly able to get the sensors and transmitters he needed.
Ok Cool Chris thank you for this as an option.