Insurance bounced my CGM prescription

@Pianoplayer7008, I am really sorry to read this! :frowning: What reason are they giving now?

Should we start a thread on this and see how we can help you go through their hurdles?

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Are your charts still coding you as gestational diabetes instead of as type 1? I am wondering if that might be a factor in their denial…

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It’s the same thing they keep saying - my policy specifically states CGMs are covered through the pharmacy coverage, but when we try to send it through them, they either come back saying we haven’t met a $4k deductible (I don’t know where they’re getting that number), so we would have to pay for the entire thing, or that it has to be obtained through my medical insurance under DME. I haven’t even had the mental energy to deal with that on top of everything else I have going on right now, so that’s all I know at this point.
@Sam, I was diagnosed pre-pregnancy, so LADA is what was originally in my chart.

And you’re working on this with a Dexcom rep directly? Their sales people sorted out all this sort of bs for me…

I’ll have to try contacting Dexcom, I guess. I think I talked to one at the beginning of all of this and she was getting the same $4k/pay out of pocket thing, but since then, I’ve only spoken with insurance and Byram reps.

Wish you luck with it-- they’re covering a significant portion of your insulin right? So that must be a seperate copay for the device coverage… that’s a lot…

Haha, well, I don’t really know what the OOP cost for the Novolog I picked up recently is, but I paid $150 for a box of cartridges - I’m guessing that’s pretty good. They still refuse to pay for Afrezza, though, hopefully just until I finish “trialing” the Novolin. And that’s just my diabetes-related grief…also appealing them denying coverage for baby’s delivery because the midwife on call at the time happened to be out of network (because I was totally in control of that!). I DO like having insurance, because it has saved us tons of money, but sometimes I also really hate it.

ETA: sorry for hijacking the thread! :grimacing:

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Don’t worry Em, Obama fixed healthcare;)

Michel loves it when I say that


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We appealed something similar and won (got an MRI in network, but the radiologist who interpreted it was out of network). So my guess is you are likely to win there.

We HAVE to somehow help you deal with this Dexcom thing. It will make a big difference to you, I think.

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I have been so looking forward to the difference it would make! Just an hour before the call, I was thinking I couldn’t wait for it since the Afrezza I took at lunch didn’t work out so well, and I’ve been hoping a CGM would help with the timing.
@Sam has already helped by mentioning the Dexcom rep - I’m not sure I would have thought to call them directly.

Dump Byram ASAP. We had a heck of a time getting anything from them. Honestly, I don’t know when EH got approved for the Dexcom, but Byram was such a hassle that it put us off of even caring to use the CGM for a while. Which is sort of awful to admit, but it’s true. Such a hassle with them.

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I’m not sure, you may already be past the point of their usefulness… but it’s worth a try

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Is that an option? Whoever my plan goes through? Carecentrix I think? Is only option for me-- though I’ve never had great reason to pursue it

Is it possible for your partner to take on some of the burden of dealing with the insurance? With your new charge AND your recent diagnosis, this is not an easy load.

We could help you figure out and write arguments for the appeal.

I am not trying to push or be nosy, you understand.


@TravelingOn, wow! I’ve used them before for something else and didn’t have an issue at all (ironically, thanks to Obamacare LOL).

@Sam, I’ll try anything at this point!

It has been for us. We call Dexcom directly now and they seem to manage to get our sensors delivered to wherever we want them in a moderate amount of time.

Byram repeatedly sent our sensors to an out dated address and then blamed us.

We eventually gave up for a while. That was dumb, I don’t want to give up anymore. Anyhow, we switched to using the Dexcom contact phone number and it’s been way better. UHC insurance now, different carrier before, still an option.


Yup, he’s been trying to help out, too, with the several things we’ve been dealing with insurance over (and it’s ok; I don’t think you’re being pushy or nosy!).