BCBS of MO

I have BCBS of MO. As Elizabeth said, BCBS coverage isn't always the same for each area, that being said... BCBS in Missouri had items that applied to me that they want for CGMS (such as my Dexcom) to be covered. Prior to trying to get a CGMS (Dexcom), I found out what my BCBS has as a list to get approved and these are some of the items...

1) Over 25 years of age;
2) Type I Diabetic for X amount of years (which I've had since 1980);
3) At least 3 times a week a blood sugar level of 50 or less;
4) Patient testing at least 6 times daily - or X amount times daily (I would test 10 to 18 times daily and still have lows);
5) Hypoglycemia unawareness;
6) A1c over 7% (my A1c has ranged between 5 to 6% over the last 5 years but I have had a lot of lows);
7) Hospitalization or emergency personnel sent for help for hypoglycemia and/or hyperglycemia;
8) Have night sweats from blood sugar level dropping (forgot name of this condition but I had it - you knowthe condition when your body's liver has to take a "reserve" of sugar to bring up your blood sugar level because you've dropped so low?).

I originally tried to get the Navigator and as the backorder was 2 months long and I needed something ASAP due to my hypoglycemia unawareness, Edgepark got me the Dexcom and said I was approved immediately by BCBS = which was not true (I was not approved prior to receiving Dexcom). I did not get an official approval from BCBS until 2 months later (after me making lots of calls back and forth to both Edgepark and BCBS).

I would call and ask to speak to a "caseworker" or ask to have a "caseworker" assigned to you, then find out what you need to be approved for a CGMS and which products are most likely to be approved, ask if you should contact Dexcom/Abbott/Medtronic directly or if you should have your Endo contact company (Endo usually has a packet of info they have to fill out on you and usually need bloodwork, your written blood sugar levels from a glucometer for a certain period of time, sometimes needed would be paperwork showing amount of insulin to food ratio, etc... this would probably more apply to GHP who tend to find any reason to not approve insulin pump or CGMS as to show that patient is not *trying* and to say that it is the person's fault, etc.).

Good luck on getting approval. Dexcom has helped me and since getting it in May, I've changed my basal rate 5 times! Another thing is that the first week, during the night I would have at least 3 lows PER night (meaning Dex woke me up for a low, I took sugar and then bg went up but then dropped again; Dex woke me up again and I took more sugar/then bg went up and then another round of low...). The first week I didn't get sleep as I didn't realize I was having such a bad problem with lows throughout night. Prior to CGMS even when I would set an alarm at 2 am prior to CGMS, I still didn't catch the lows throughout night.

Again good luck!
Cina