Decision Moves Continuous Glucose Monitors Closer To Medicare Coverage
Continuous glucose monitoring (CGM) devices approved by the FDA for use in making diabetes treatment decisions are durable medical equipment, according to a decision today by the Centers for Medicare & Medicaid Services (CMS). That determination removed a major roadblock to the devices’ coverage under Medicare. Today’s decisions mean that CGMs approved by the FDA for use in making diabetes treatment decisions are eligible for reimbursement under Medicare. Today’s decision creates a pathway for Medicare coverage for the devices that will bring the nation’s largest insurer in line with the vast majority of the country’s private payers. Although the significant benefits of CGM use have been known since 2008, CMS had previously refused to consider covering the devices under Medicare, saying they did not meet the statutory definitions of durable medical equipment or any other category the agency could cover. Today’s decision removes that impediment. “JDRF is encouraged by this decision, which will bring us closer to Medicare coverage for continuous glucose monitors,” said Aaron J. Kowalski, PhD, JDRF’s Chief Mission Officer. “I want to thank the tireless JDRF advocates and Congressional champions who have made this progress possible.” JDRF has been the leading advocate for widespread adoption of CGM technologies to manage T1D and for public and private payer coverage for their purchase and use. JDRF has spearheaded the drive to obtain Medicare coverage for CGM devices, marshalling research, expert testimony, allied organizations, and JDRF advocates from across the nation. JDRF met numerous times with officials at CMS and with others in the executive branch to urge them to provide access to this life-changing technology using the agency’s existing auth Continue reading >>
How Much Does Continuous Glucose Monitoring Cost?
back to Overview Continuous glucose monitoring (CGM) cost and insurance coverage. Does that phrase make your head spin? These were hot issues in response to our last article where I asked about your experience with CGMs. Like anything we’re considering, the financial impact is a big part of the decision-making process. But because the cost depends so much on your insurance coverage, it can be confusing to find out how much you’ll end up paying. And maybe it’s just me, but I don’t like talking to my health insurance company. It feels complicated and I’m rarely confident in the information I get. Additionally, the information changes depending on when during the benefit year I call. What’s the importance of a benefit year? Typically (in the U.S.), health insurance policies are done on an annual basis, and things like deductibles and out-of-pocket maximums, which act like thresholds, are reset. You’ll usually find your cost to be lower later in the benefit year after they’ve been met (even $0 in some cases). For many, the benefit year is the same as a calendar year, so the end of the year might be a smart time to ask about your coverage again. You might be in for a pleasant surprise for the holidays! More to consider? We also have to keep in mind that each employer’s policy can be different, even with the same insurance company. So even though you and your neighbor both have health insurance from the same company, your individual coverage may be different because you work for different employers. An opportunity? But rather than thinking of all this complexity as a barrier and feeling intimidated by it, I believe it creates an opportunity to leverage companies like Dexcom. They have people whose full-time jobs are to dive into our insurance plans and uncov Continue reading >>
How Likely Am I To Get Insurance Coverage For A Continuous Glucose Monitor?
Nationwide, approval for CGM monitor for diabetes is still a bit patchy, with a dizzying array of requirements to get covered. Generally speaking, type-1s have an easier time getting covered than type-2s, especially if they are hypo unaware, have had more than three documented readings at or below 50 mg/dL in a month, and more especially if they’ve had an Emergency Room visit. In theory, all it takes for approval of a CGM monitor is a signature on a form called a “Letter of Medical Necessity,” which also doubles as a prescription. Each CGM company has fill-in-the-blank letters for your doc on its website. In reality, it’s quite a bit more difficult. The insurance company will probably want to see your doc’s notes from the last two visits, recent lab work, and 30 days or more of fingerstick meter data. It’s common to be rejected on the first round but approved on appeal.The insurance company has nothing to lose by trying to say “no.” Don’t let their game get your blood pressure up, but be persistent. Once covered, your CGM will be paid for by your health insurance under what’s called the Durable Medical Equipment, or DME, portion of your policy. Overall costs will depend on your coverage. Beyond Fingersticks: The art of control with continuous glucose monitoring Everything you ever wanted to know about CGM (but didn’t know to ask)!Continuous Glucose Monitoring (CGM), the revolutionary technology that’s poised to completely change diabetes care, gives you... Continue reading >>
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Continuous Glucose Monitoring: Everything You Need To Know
Continuous glucose monitors or CGMs can be a lifesaving device for people with any type of diabetes. They continually check your blood sugar 24 hours a day and alert you you before you begin experiencing low or high blood sugar levels. They can reduce the number of times you have to check your blood sugar each day which is welcome news for everyone with diabetes! Insurance coverage is changing this year with Medicare jumping on board also, so this is the time to learn about this awesome piece of technology available to you. I know there are a lot of questions surrounding the use of continuous glucose monitoring, so we will break it all down here for you! What is a CGM and how does it work? Is it right for me? Will I still have to check my blood sugar? What choices do I have currently on the market? Will my insurance cover a CMG? How much will it cost? Can I travel and play sports with a CGM? In this article I will answer all your questions. What Is Continuous Glucose Monitoring (CGM)? A continuous glucose monitoring system or CGM is a system that does just what it sounds like, it monitors you glucose (blood sugar) continuously…well, every 5 minutes, 24 hours a day! You are able to see what your blood sugars are with a receiver; the data is transmitted from a sensor which is inserted right beneath your skin which is attached to a transmitter which sends the data to the receiver. Now, the newest system are even integrated with a Smartphone; with this advancement you can check your data right from your cell phone. For parents with children, this technology is peace of mind, allowing them to check their child’s blood glucose level any time-day or night. There are two different types of systems: The first is a personal continuous glucose monitoring system that you wear a Continue reading >>
Continuous Glucose Monitoring
Topic Overview When you test your blood sugar, you learn your blood sugar level at that time. But you can't tell what's happening to your blood sugar the rest of the time—especially overnight. A continuous glucose monitor, or CGM, can do that for you. It reports on your blood sugar at least every 5 minutes, day and night. And it sounds an alarm if it sees that your levels are headed out of range. How does a continuous glucose monitor work? A CGM has three parts. You wear one part—the sensor—against your skin. It has a tiny needle that stays under your skin. A transmitter is attached to the sensor and constantly reads your blood glucose level. It sends this information to the other part of the monitor, a wireless receiver that you (or a caregiver such as a parent) wear on your belt or in your pocket. At any time, you can look at the receiver and see what your glucose level is. You can see if your level is going up or down—and how fast. You can download the information to your computer and see the trends and patterns of your glucose levels. You note on the receiver when you eat, do exercise, and take insulin. That way you can see how those activities affect your blood sugar throughout the day and night. All this detailed information gives you and your doctor a better idea of what your treatment needs are. Continuous monitors are not as accurate as standard meters. At least once or twice a day, depending on the type of monitor you buy, you will have to prick your finger and use your standard meter to confirm what the CGM is telling you. A CGM is constantly measuring your blood sugar. This information helps some people who have diabetes make decisions about what to eat, how to exercise, and how much medicine to take. Using a CGM has been shown to give people with ty Continue reading >>
Cgm Insurance Coverage
Although Medicare does not currently pay for CGM, several major private plans offer some level of coverage. These include: Blue Cross/Blue Shield Aetna Cigna Humana United Healthcare Kaiser Permanente Wellpoint CGM is usually considered “durable medical equipment” and is subject to the same deductibles and copays as other types of DME. Every CGM company has a team of specialists dedicated to helping you obtain maximum coverage. Do your best to comply with their requests and supply them with the information they need to support your case. People with Type-1 (insulin-dependent) diabetes often qualify for insurance coverage, particularly if the following criteria are met: A history of hypoglycemia, documented in the physician’s chart/records Presence of hypoglycemia unawareness (lack of symptoms during the early phases of hypoglycemia) Erratic blood glucose levels Suboptimal HbA1c Frequent blood glucose monitoring Having completed diabetes self-management education In some cases, people with Type-2 diabetes, whether or not insulin is used, can obtain coverage if many of these same conditions exist. Most plans require the CGM to be prescribed by an endocrinologist. Letters from both you and your physician, supporting your need for CGM, are often helpful. And persistence pays! If you are denied for coverage the first time around, go through the appeal process. Many people who were initially denied are approved for coverage after the second, third, and even fourth round of appeals. Whenever possible, request an “external” appeal. This requires your health insurer to pay a physician who is not employed by their company to review your case in detail. An external appeal will usually cause the health insurance company to overturn their decision and begin covering your C Continue reading >>