CGM device not covered anymore at AXA insurance

[Veltmuis]

Hi everyone,

I wanted to share my recent experience with AXA regarding my Dexcom CGM coverage and see if others have faced similar issues.

I’ve been using a CGM as part of my Type 1 diabetes management for years. Until recently, my insurance (AXA) approved my claims for the Dexcom CGM, but my latest claims were suddenly denied.

Their reasoning? They now classify CGMs under “external prostheses and appliances” (like crutches or joint supports) and claim it’s a “personal choice” rather than a medical necessity.

This is in my eyes not acceptable because:
1. They covered it before – Why the sudden change?
2. It’s not optional – A CGM is essential for managing Type 1 diabetes effectively.
3. Denial puts health at risk – It helps prevent severe highs/lows and long-term complications.

I’m reaching out to this community to ask:
• Has anyone else had their insurance deny CGM coverage?
• If so, how did you handle it?
• Any advice on appeals or next steps?

I’ve already challenged AXA’s decision and involved my endocrinologist, but I’d love to hear how others have navigated similar situations.

Thanks in advance for any insights!

Mark

 

[everydayupsanddowns]

Welcome to the forum @Veltmuis

Sorry to hear you have suddenly had health insurance claims denied that were previously approved. I can see how that would be extremely frustrating!

I’m not sure members here will have much insight about health insurance claims, as it looks like you are posting from overseas.

CGM in the UK is offered on the NHS to people with diabetes that meet NICE criteria. The vast majority of people with T1 in the UK now have access to a choice of sensors on prescription.

You may have more luck on a US diabetes forum, where health insurance is more part of the landscape.

 

[Veltmuis]

Welcome to the forum @Veltmuis

Sorry to hear you have suddenly had health insurance claims denied that were previously approved. I can see how that would be extremely frustrating!

I’m not sure members here will have much insight about health insurance claims, as it looks like you are posting from overseas.

CGM in the UK is offered on the NHS to people with diabetes that meet NICE criteria. The vast majority of people with T1 in the UK now have access to a choice of sensors on prescription.

You may have more luck on a US diabetes forum, where health insurance is more part of the landscape.

Hi @everydayupsanddowns,

Thanks for your rapid response.

My insurance company is AXA in the UK (before I left Europe in 2006 to Singapore) and have been using ever since (as it is nearly impossible to get proper healthcare coverage with a pre-existing condition). If I understand you correctly people on this forum generally do not have private insurance experience, but use NHS instead?

Appreciate the clarification.

Thanks!

 

[everydayupsanddowns]

Most members here would rely on the NHS for routine care. Some may have private insurance too.

Because Libre2+ and Dexcom 1+ are now widely available in the UK on prescription there would be less need for members here to rely on health insurance claims.

For Dexcom G6 or G7, these are available to those who meet NICE criteria demonstrating clinical need (and cost-effectiveness of the devices). I would imagine that a health insurance company could effectively argue that if you don’t meet NICE criteria for “needing” CGM, then it is an optional extra as AXA have suggested to you.

Either way, I guess it’s in the interests of health insurance companies to pay out as little as they can get away with?!

Good luck with your appeal.

 

[helli]

I have private medical cover through work from before I had diabetes. However, it has never covered anything to do with day to day management of the condition.
So things like insulin, cgm insulin pump, etc. are all funded by the NHS or self-funded.

I think you may struggle with the idea that a CGM is essential. Although they certainly help, I would not put them in the same category as insulin and test strips. I sometimes take a CGM break when I feel I am obsessing about my numbers or relying on tech too much.
I fear I will lose hypo awareness if I don't take breaks.

You don't mention which Dexcom you are using. If it is the G6 or G7, the Dexcom ONE + maybe worth self funding. Or self funding some of the time - before the NHS funded my Libres, I self funded every 2 weeks out of 6.