Humana ChoiceCare CGM (In-Network) Supplier

Humana ChoiceCare Network

Authorized In-Network CGM Supplier

We Are An Authorized In-Network ChoiceCare Provider

Current Humana ChoiceCare CGM Insurance Requirements (Jan. 2023)

Humana has one of the more stringent insurance authorization requirements for qualifying for CGM Systems. They are following the initial Medicare Guidelines for CGM

In order to be eligible for coverage of a Continuous Glucose Monitor (CGM) and related supplies, Humana requires that the beneficiary meet all five of their criteria:

Diagnosed with Diabetes: Have a diagnosis of type 1 or type 2 diabetes mellitus.

Insulin Dependent: You require multiple daily administrations (Three (3) or more) of insulin or an insulin pump.

Daily Adjustments to Insulin: Your lifestyle require frequent adjustments based on your BGM or CGM testing results.

See Your Doctor 2x per Year: Have an in-person visit with your treating doctor within 6 months ordering your CGM. Follow that up with an in-person visit every 6 months following initial prescription of the CGM to assess adherence to their CGM regimen and diabetes treatment plan.

WHAT ARE MY OPTIONS IF I DON'T QUALIFY?

If you don’t qualify initially qualify for Humana’s Criteria there are a couple of Options.

A health or disability extenuating circumstance: If you have a health or disability that makes using a standard BGM a challenge or less safe your doctor can provide you with a certificate of medical necessity that in some cases will allow you to qualify for a CGM if you don’t meet the above criteria. Call us and we can give you additional guidance based on your condition.

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Evaluate other insurance providers: There are other providers that have lower standards for qualifying for a CGM systems that you can explore.

Cash monthly subscription: Smiles offers a CGM monthly subscription for the Abbott Freestyle Libre 2, Freestyle Libre 3, and Dexcom G6 systems. Get a fixed monthly cost for your sensors, reader & patches! Call our team for details.

Wait for changes in the requirements: Medicare guidelines for CGM approval are expected to relax mid 2023. The proposed changes will make it much easier to qualify for a CGM system. Humana has historically followed Medicare’s CGM guidelines for CGMs and we expect them to continue to follow suite.

Check our Medicare Status

NPPES NPI Registry (hhs.gov)

Together, we’re building a better way for millions of Americans by making it easier and faster for everyone to access the solutions they need to live their lives.

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