Useless form letter. (And BTW, ADA’s chief scientist seems to think that even regular bG testing isn’t “proven” enough to justify insurance coverage. ADA is not your friend, or mine.)
“The State Division of Insurance” will almost certainly NOT investigate one individual claim which hasn’t even been brought to the proper authority yet. You have a contract dispute, in which they’re supposed to cover “medically necessary treatments” but claim that this particular treatment falls into an exception. (Which is written into your contract; if it is only in experimental/investigational status, then they CAN refuse to cover it.)
Where do USA citizens and Companies settle contract disputes?? Civil Court. THREATEN them with civil court action, and they’ll probably cave immediately-- because they know that they’ll lose this question:
"Is the device APPROVED for patients with hypo-glycemic unawareness and a history of dangerous bG excursions, or is it still in “Preliminary Market Approval”?
There is absolutely, positively only ONE answer to that question. You win, and they lose. They know this. So, they will agree to cover for you, because losing a civil court case sets a referenceable precedent for CGMS devices (very bad). It also creates a lost case against THIS particular MD in Civil Court, and that’s even worse-- every time he renews his license in the future, he’ll have to list the case, show the details, and (in general) fill out tons of paperwork to show that he IS competent.
If it doesn’t sound like I know what I’m talking about, you certainly can go ahead with ADA and State Regulators and more appeals and whatever. But they’re not the appropriate venue, and they probably won’t work. You won’t have to go to Court-- just the THREAT, with such severe consequences and the near certainty of losing, is enough.
Does your medical record include specific instances of these Hypos with Unawareness, and dangerously varying bG’s ??? Because, if they’re not in your records, they aren’t “reliable”. Even direct testimony by your work-mates and family is open to attack, so be sure that your records are complete.