Aetna PPO—Approved my CGM—first appeal @ 90% coverage
–I sent 2 letters from my Endo—I typed both endo letters(basically copied from the sample letters that Dexcom provided), emailed them to my dr and let her fill in the diagnosis code(which I had researched and suggested her to use 250.83— which is something like “Diabetes mellitus with other specified manifestations Type I uncontrolled” ) — which if they needed elaboration on, she was prepared to write an additional letter about hypoglycemia unawareness related to my specific case.
–sent a personal letter describing my specific need
–sent an excel spreadsheet - 4 months worth of color coded with highs and lows marked in different colors. (see attached—if you want to feel better about your control, look at this)
—sent average meter tests per day relating to A1C results.
A1C 7.3% testing 4 times per day
A1C 6.6% testing 6-10 times per day
A1C 6.0% and 6.1%, using CGM testing 3-4 times per day
—sent documentation of Pre-CGM A1C results and Post-CGM A1C results
First Appeal approval is unheard of in past experience…maybe Aetna is finally coming around.