DEXCOM G6 insurance pre approval (1436)

How can I get a Dexcom G6?

First, we need to find out if it is a prescription benefit or a medical benefit. The diabetes clinic will check with your insurance company to find out. This will take a few days.

If the Dexcom G6 is covered as a pharmacy benefit

1. You will be called about the cost.
2. A prescription can be sent to the Skywalk Pharmacy or your preferred pharmacy.
3. Some insurances also need a prior authorization. This means that the insurance company needs to look at your child’s medical history and decide if they will pay for part of the CGM. This part of the process can take 1 to 2 weeks.

If it is not covered as a pharmacy benefit, or if the pharmacy benefit costs too much:

• A durable medical equipment (DME) supplier (like Edgepark, Byram, or Solara) will work with your insurance. The process is:

1. Clinic gives insurance information to Dexcom.
2. Dexcom contacts a DME that works with your insurance.
3. Dexcom sends a form to the clinic to fill out.
4. Clinic sends the completed form to the DME distributor.
5. DME distributor sends the form on to your insurance company.
6. Your insurance company decides if they will pay for the Dexcom.

• Paperwork for the DME may not be able to be completed until staff have enough data to fill it out (#4).
• If insurance approves the Dexcom G6, you will get it and other supplies from the DME distributor. Insurance does not always approve the DEXCOM G6.

Important information about the DEXCOM G6

• Plan for 4 to 8 weeks from the start of the process to your child getting the Dexcom G6.
• If you haven’t heard from the pharmacy or Dexcom after 4 to 8 weeks, call Dexcom at 844-607-8393.
• Many insurance companies require a patient to be checking their blood sugar with a blood glucose testing meter at least 4 times per day for 30 days.
• State insurance requires a trial CGM before a home CGM will be approved. This can be scheduled with the clinic. A provider will need to review the data before a home unit is approved.
• We do not get updates on orders at the clinic. Please call Dexcom (Customer support: 888-738-3646) and your insurance or CGM distributor.

When your child gets the device

• Call the clinic to schedule an appointment for a CGM education class. Or
• Start your Dexcom at home. Use online resources to find the information you need for a home start: https://www.dexcom.com/guides