Following up on our previous Insurance Primer blog, we’re now getting detailed. This blog post walks you through Dexcom insurance specific resources available if your CGM device of choice is the Dexcom.
If you have any of your own tips, suggestions, success stories, or challenges, share them in the comments below.
Disclaimer: Please check out CIM’s Partners Page to learn more about the companies we work with. This post was not paid for and does not represent sponsored content, but it’s important to recognize that we may be biased based on the fact that some companies highlighted below support CIM in different ways. We still thought this info was important for you to know about.
Insurance and Dexcom: The basics
- Do not try to navigate insurance on your own. Dexcom has a team to do this for you. You can get in touch with them via phone at 1-844-832-1810.
- About 85% of insurance providers in Canada cover Dexcom G5 in their plans. and coverage continues to evolve – if you didn’t have coverage a few months ago, try again.
- Based on feedback from our community, the following insurance companies offer some form of coverage: Sunlife, Greenshield, Manulife, Great-West Life, Desjardins, Medavie Blue Cross, Industrial Alliance, Empire Life, Equitable Life.
- Our community has told us the following insurance companies do NOT currently offer any CGM coverage (read below on how you can help make a difference with this): ClaimSecure, Manitoba Blue Cross, Saskatchewan Blue Cross
- If you don’t have coverage, don’t give up! Appeal to your insurer, employer and/or union.
- Dexcom does not offer direct billing. You should be prepared to pay upfront for your Dexcom supplies and then submit to your insurance company
Step-by-Step: Investigating Dexcom CGM coverage
The best first step is to contact Dexcom by filling out their online form, and a representative will get in touch with you directly for next steps. You will then fill out a Patient Information form, giving Dexcom permission to contact your insurance provider on your behalf. A Dexcom Account Specialist will get in touch with your insurance company and ask them to forward you information specific to your coverage for the Dexcom CGM system.
If there’s anything we’ve learned as we’ve been investigating this topic, it’s been that each insurance company is SO nuanced. Some require proof of your previous 3 months of finger-poke BGs. You could be automatically denied if any of those days has less than 4 results listed. Some require a form to be filled out by your doctor, but the language in the form is confusing. One wrong box checked can result in automatic refusal. These are the things that the Dexcom team knows inside and out and can provide help with to make the process as clear as possible. Their team ‘gets it’. If you’ve made the decision that you’d like a Dexcom CGM, we can’t say this enough – CALL THEM! They are there to help.
After a Dexcom Account Specialist reaches out to your insurance provider, you’ll hear from the INSURANCE people, not Dexcom. Your Insurance provider will not forward anything to Dexcom for confidentiality reasons. Once you receive that info back from them, you’ll have a few paths in front of you depending on their response. In almost all cases, it makes sense to contact your Dexcom Account Specialist directly. Remember, they know how to do this.
Possible Responses:
YOU’RE APPROVED.
Great! Congrats! Fire a note to your Account Specialist. Consider including the letter your insurance company sent you. You’ll then be able to walk through the next steps in receiving your Dexcom. If you are a first time Dexcom user, you may also qualify through the end of May for their Starter Kit Offer with a pretty sweet discount.
YOU’RE DENIED.
Ugh. Frustrating. Okay – next step. Call your Dexcom Account Specialist and let them know what it says in your letter. They may be able to guide you on how to advocate for yourself, provide additional information such as key messages, new evidence, or other resources that may help with your case. The point is, don’t give up. If you don’t ask – you won’t get. Keep appealing to your insurance provider and HR department. Try to find others in your organization wanting CGM coverage so you can advocate together. There is strength in numbers.
We hope that this information has been helpful to the community as we work to help eliminate barriers to receiving the best possible diabetes care for you. Please leave us your questions and comments below specific to accessing Dexcom CGM through insurance and we’ll do our best to get you the information you need.
FEEDBACK, ADDITIONS, CORRECTIONS? LET US KNOW!
Do you have an idea for our Lessons Learned blog? Something you have always been wondering, or something you’ve learned that was a real ‘AHA’ moment for you? Get in touch. Send your ideas to info@connectedinmotion.ca
