How to Convince Medicare to Pay For CGM

Note-Make sure you buy supplemental medicare with a 3 star rating or greater. You can find this on your medicare booklet. If you can, get a PPO plan.

An acquaintance said, “My Medicare won’t pay for a CGM (Continuous Glucose Monitor)?

I suggested that he call his insurance company and ask, “Why?”

As we all know, insurance companies don’t want to pay for anything.

I then suggested that he has his Endocrine ask the insurance company to pay for a temporary CGM (3 days use), since he has no symptoms of low/high blood-sugars. Once Endocrine receives a 3 day reading from CGM and have lab drawn for a C-peptide test, both results are sent to insurance company and insulin pump supply company. Insurance company want proof that you have Type 1 diabetes, hypo/hyper-unawareness, and blood-sugar fluctuations throughout day. Better yet, a representative from Medtronic, Dexcom, Accu-chek… company would know the proper procedure for getting a temporary CGM.

Man replies,”They know that I have Type 1 Diabetes. C-peptide tests are done when you’re diagnosed with diabetes.”

“It doesn’t matter. If you want the CGM device, you have to play the game. I know, you know, and your endocrine knows that there’s no cure for Type 1 Diabetes. However, insurance companies don’t care.”

Man replies, “But they know that I have Type 1 diabetes…”

“Okay. You told me your story and I’m telling what to do. Take it or leave it.”

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