Quick update: found out today that I was denied for the Dexcom. Feeling down, feeling crappy. I will rebound eventually but I am going to take a little time to wallow and feel a little sorry for myself. Just wanted to throw this out there, and have also update my personal blog, link is above.
And poop on Med Mutual.
Is Med Mutual what it sounds like (a mutual insurance company-member owned)? If so, they are supposed to work harder to do what is best for their members. I’d suggest talking to your MD or Dexcom again and appealing the decision.
That’s my plan.I am waiting for them to call me about the appeal process. Hopefully I have better luck the second time around.
Appeal it. Most insurance companies now see the value of a CGMS and will supply them. “No” is just the first response. This is why health insurance for profit is such a bad paradigm. I’m sorry they have made your life that much more difficult. Don’t give up. It’s worth fighting for.
My first CGMS was denied and I won my appeal. Their letter stated that they did not pay for things that were a convenience. I was passing out before getting it so it was not a convenience. Some people have their doctors appeal the decision, but I felt I could do a better job than my doctor would. I think I put everything but the kitchen sink in my appeal letter!
I have already started formulating my letter! Thanks for the feedback, guys!
Appeal. Denial is standard when first applying. Back up your appeal with studies, examples of any low blood sugars in the past few months (any instances of 50s, particularly multiple instances), whether or not you are ever hypoglycemic unaware (this happens to a lot at night); demonstrate you need cgms for safety.
Also make sure you review the paperwork that physician submitted. I was denied and then found out the doc had submitted the wrong dx as a T2. You may want to start here, since an error in paperwork is an easy fix.