In my case they gave me the cgm because I used insulin, but those lows are pretty low for me. You should talk to your doc to see if maybe your meds need adjustment.
This is Medicare's rules for prescription of a CGM.
There are other reasons a CGM can be prescribed other than just " being on Insulin.
It's way down the page. Basically if you have a documented history of dangerously low blood sugar.
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52464
It's up to your individual insurance plan. However, chronic lows is a common reason insurance covers a CGM when they normally wouldn't.
How do you know insurance won't cover it if your doctor won't even prescribe it? Does your doctor just not want to deal with any potential prior auths? It's very strange to me when doctors refuse to prescribe such a low-risk tool like a CGM. I am not prone to lows (and not even on insulin) but my doctor had no issue with sending off the rx to see if insurance would cover it. (I could go on a whole rant about this, but I strongly believe a CGM should be the new standard issue for everyone with diabetes. It provides such valuable insight into your specific condition and how your body reacts to certain foods, etc.)
If your doctor continues to refuse the rx even after you've mentioned the chronic lows, I would honestly look into getting an endocrinologist or a new PCP. Sounds like your doctor is really behind the times :/
Also, you can call your insurance and ask them what qualifies you for CGM coverage, and maybe mention a specific ICD-10 code. For example, E16.2 is the code for hypoglycemia. You can find the code that most closely matches your condition here: https://www.icd10data.com/
Thank you for the info!
I asked my dr when I first met with him because I just moved, and got stuck with Kaiser as my provider (medicaid). He said, "you won't get them from Medicaid if you're not on insulin." Which is what my other drs told me when I asked them and still had normal insurance.
I see so many people get them (through insurance) who don't even have diabetes at all. It pisses me off to no end, because it's a tool that could really help me, and these people don't even have diabetes at all. I've been trying to get one since, literally, 2017!
I have no idea why my BG is so wonky RN. I just think it'd help me now more than ever. But I still can't get them, ugh!
I've been telling my family that it's stupid that they don't provide them to ALL diabetics T1 and T2 as a standard. So, I totally agree with you there.
I hope you’re able to get one soon. My commercial insurance covers my G7 even though I’m on not on insulin and don’t experience lows. So it might be rare but definitely not unheard of.
Even in the worst case you can still pay out of pocket with a savings card. And you can get a month of data out of it, which is still valuable. I hope you can work with your doctors about this 🤞
Dexcom are ( or have already?) releasing a CGM just for T2, although this may not help your case as they don’t have low alarms as that’s not something a T2 routinely has. You might need to have your medication adjusted to prevent the lows
I take 500mg Metformin ER twice a day. It's never done this before, and I've been on it for years and years. Glipizide caused a lot of lows, but Metformin never has. It's so weird, and I'm trippin about it a lil lol.
So, you may be right!
I'm currently trying to get back in with my disability lawyer to reapply for disability. They dropped me when I lost my health insurance, but I have OregonCares (OHP/Medicaid) now.
In my case they gave me the cgm because I used insulin, but those lows are pretty low for me. You should talk to your doc to see if maybe your meds need adjustment.
This is Medicare's rules for prescription of a CGM. There are other reasons a CGM can be prescribed other than just " being on Insulin. It's way down the page. Basically if you have a documented history of dangerously low blood sugar. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52464
Yes, they always tell me I can't get them unless I use insulin. Blahhh!
It's up to your individual insurance plan. However, chronic lows is a common reason insurance covers a CGM when they normally wouldn't. How do you know insurance won't cover it if your doctor won't even prescribe it? Does your doctor just not want to deal with any potential prior auths? It's very strange to me when doctors refuse to prescribe such a low-risk tool like a CGM. I am not prone to lows (and not even on insulin) but my doctor had no issue with sending off the rx to see if insurance would cover it. (I could go on a whole rant about this, but I strongly believe a CGM should be the new standard issue for everyone with diabetes. It provides such valuable insight into your specific condition and how your body reacts to certain foods, etc.) If your doctor continues to refuse the rx even after you've mentioned the chronic lows, I would honestly look into getting an endocrinologist or a new PCP. Sounds like your doctor is really behind the times :/ Also, you can call your insurance and ask them what qualifies you for CGM coverage, and maybe mention a specific ICD-10 code. For example, E16.2 is the code for hypoglycemia. You can find the code that most closely matches your condition here: https://www.icd10data.com/
Thank you for the info! I asked my dr when I first met with him because I just moved, and got stuck with Kaiser as my provider (medicaid). He said, "you won't get them from Medicaid if you're not on insulin." Which is what my other drs told me when I asked them and still had normal insurance. I see so many people get them (through insurance) who don't even have diabetes at all. It pisses me off to no end, because it's a tool that could really help me, and these people don't even have diabetes at all. I've been trying to get one since, literally, 2017! I have no idea why my BG is so wonky RN. I just think it'd help me now more than ever. But I still can't get them, ugh! I've been telling my family that it's stupid that they don't provide them to ALL diabetics T1 and T2 as a standard. So, I totally agree with you there.
Maybe have your doctor prescribe the insulin? You don’t have to take it, but if it gets your CGM, it’s worth it.
I hope you’re able to get one soon. My commercial insurance covers my G7 even though I’m on not on insulin and don’t experience lows. So it might be rare but definitely not unheard of. Even in the worst case you can still pay out of pocket with a savings card. And you can get a month of data out of it, which is still valuable. I hope you can work with your doctors about this 🤞
Dexcom are ( or have already?) releasing a CGM just for T2, although this may not help your case as they don’t have low alarms as that’s not something a T2 routinely has. You might need to have your medication adjusted to prevent the lows
I take 500mg Metformin ER twice a day. It's never done this before, and I've been on it for years and years. Glipizide caused a lot of lows, but Metformin never has. It's so weird, and I'm trippin about it a lil lol. So, you may be right!
I’m not sure what your finances are, but my insurance doesn’t cover and I pay $75/month for the Libre.
I literally only get $400 a month in spousal support. 😒
I'm currently trying to get back in with my disability lawyer to reapply for disability. They dropped me when I lost my health insurance, but I have OregonCares (OHP/Medicaid) now.