May 25, 2022
Question from Brookville, OH, USA:
Why doesn’t health insurance cover the costs of a Dexcom? I have had to pay out of pocket for my child’s Dexcom. I believe the Dexcom and our ability to monitor my child keeps him healthy and out of the hospital. So what needs to be done to have a Dexcom covered under insurance? What can we do to make sure other people don’t have this problem too?
Every insurance is different, and it is unfortunate that it is this difficult!! I would recommend calling and asking:
1. If they cover any type of continuous glucose monitor. They may want you to use a different kind – in which case you can ask your doctor or healthcare team to do a statement of medical necessity, prior authorization, or even peer to peer review if they won’t accept either of those.
2. You can ask if your insurance will cover Dexcom through the Pharmacy Benefit instead of Medical Benefit, which may be the issue.
3. You can ask what supporting documentation they are requiring – sometimes they need specific diagnosis codes, supporting lab results, or blood glucose monitoring logs.
If none of these work, I would recommend working with your healthcare team to see if there are other options for your child and you can also try the route of talking to whoever gives you insurance. So, if you’re on your work’s insurance, call HR and let them know that you’re having this difficulty and ask them to negotiate for coverage for their employees. If you’re on public insurance, it’s a little harder, and voting for people who will provide better medical coverage is helpful. There’s a group called the Diabetes Patient Advocacy Coalition that helps keep track on laws that help improve coverage for people with diabetes, I’d recommend checking their website.
Aside from all of that, the Libre is much less expensive, but if you’re using a Dexcom because your child also has a pump with which the Dexcom works, that’s not exactly ideal. But, if you’re having to pay out of pocket, perhaps you can alternate between Libre and Dexcom. Personally, I restart my Dexcom Sensors, and you can Google this to get tips on how to do it. Mine typically last about twice as long as the recommended wear. Just be a little more cautious with dosing insulin and be ready to do finger sticks if the data gets wonky.