What is actually required for your renewals

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I have heard before when going to the endo that certain tests are required by the insurance companies to get the prescription approved for certain things. This is generally stated for CGM and insulin pump supplies. For myself at least, I have never been told of a test requirement for getting a renewal of an insulin prescription (certainly new prescriptions could be different).

But for the pump and CGM, I pushed back a bit, and consulted with the suppliers I have dealt with (Edgepark and Byram), and talked to the insurance company.

I was happy to learn that in reality - again, this is for my situation, possibly different for everyone - absolutely no tests are required to get a renewal for CGM, and the only thing required to get the pump renewal is an A1C and the doctor’s notes for the visit. And it only needs to happen once a year. (the once-a-year thing is an insurance requirement).

  • So, bottom line for me, when the doctor’s office says, “You need to come back and see us in 3 months…”, I can now say, “No, I’ll see you in 12 months.”

  • And I don’t need to bring in a pump for download, or any BG meter for download. It isn’t actually required by my insurance company.

  • Also, when the endo tells me I need certain tests, I can actually just pick the tests I think are useful or which ones I want, and not waste my blood on all the others.

The endo could decide to not write the prescription if they want, but mine didn’t do that. If they did, I’d find a different endo.

I am very happy to have pushed back a little and looked into it. I am free from endo visits for a year (unless I want to go on my own). Free from any blood tests that are geared for the general diabetic population instead of being specific to what I need. And free from the non-sense BG meter downloads where they look at a 66 and circle it with a pen. And especially good to be free from doing a pump download, which would never make sense to the endo anyway, because it is just a collection of insulin dosing and basal adjustments without any actual context of why it was done.

For me it is good because it allows the endo visit time to be spent on useful info exchange instead of wasting time with that other stuff.

I know the requirements are different for everyone based on their insurance. And I know some people like pump downloads and BG meter downloads. But I mention this as encouragement for people to find out what is actually needed, instead of just doing whatever the endo says is needed.

Do what you think is valuable for you, and what is actually required for renewals. Don’t just do something because the endo says it is required. Find out what is required.

For example, if you and your endo both think you need a blood panel and you want to do it, great. But do it with the understanding of whether or not it is required for insurance approval, instead of just because someone “says so”.

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My endo absolutely doesn’t care if I come back more than once a year given my recent stable situation and in general is happy to go with whatever I’m comfortable with, but my insurance requires A1c results (so dumb, since for me they are inevitably redundant with my Clarity report) and chart notes every time they authorize a new Dexcom transmitter order. Basically, they end up paying for an unnecessary office visit and lab tests on the off chance they can use it as an excuse to deny me coverage, which never ends up being the case…

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Thanks for putting the information out there. It won’t be right for everyone, but certainly there are others that would find the idea of less physician visits attractive.

For us, that isn’t the right thing right now, but it could easily be a few years down the road. Knowing what is required and being able to choose your path is important.

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Thank goodness! Glad to hear. When my endo said see you in 3 months, I just scheduled 6months out (she’s so busy you can’t get in for 4mo anyway). Its a 2h drive each way for me and my primary does everything I need except the dexcom prescription and I see him every 6 months as well to stagger. My endo is supportive of everything I do but I usually find my own answer to questions long before my next appt.

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It can vary for everyone.

But if you have a sufficient stockpile, one way to know for sure is to not go and keep refilling your scripts until you hear that a doctor’s visit is required.

Not that I am encouraging people to not visit, but to me it is useful to know what is required, and what is just the endo saying stuff.

They are a business, and they may want to have frequent visits to make more money. It really depends on each practice, you never know.

If a 3 month visit is useful for someone, by all means, they should do it.

But I think all of that is good to know - how frequent is it useful for each person, how much of it is the endo’s desire, and how much of it is the insurance requirement.

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i know that this must be tremendously useful to those people who are wasting blood unnecessarily, but for myself, and i am certain for some others, i am on Medicare, and they require everything all the time, every 3 months or else! they even need urine samples :wink:

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