I have read some of your posts as I try to navigate the insurance hierarchy nightmare to get the MM CGM added to my daily “wardrobe”.
From what I have seen/.read many of you have fought the bureaucracy and won-CONGRATS!! . I am starting my NEXT level of appeal with Tufts of MA this week. (I am sure it will not be my last.)
The rejection made a couple of points and I know that I can address them but was unsure if any of you would be willing/able to assist.
Their statements in my denial were that it “a treatment or procedure that is considered experimental or investigative 'if reliable evidence shows that prevailing opinion among experts regarding the treatment that is more studies or clinical trials are necessary to determine its safety, efficacy, toxicity, maximum tolerated dose, or its efficacy as compared with standard means of treatment or diagnosis.”
Which is clear as mud! Can they call CGM that because it is FDA approved or is that a silly argument to make? So far, I have sent a detailed letter from my Doctor (written by a pump specialist at Jooslin clinic.), and a personal letter from me describing the need. Under the circumstances does it make sens to inundate them with clinical studies, blood sugar reading with food/carb intake?
Any assistance or documentation that you would be willing or able to provide me would be GREATLY appreciated. I look forward to hearing from you. Please feel free to contact me directly at email@example.com. I am also curious if anyone has been able to get approval from Tufts of MA.
Thanks for your time and help!