I am completely frustrated with my insurance companies turnaround. Back in January my insurance paid for 70% of my Dexcom sensors, and I was pleasantly surprised. Well after nagging Dexcom to file my claims (they hadn’t done the last three), today I received a denied statement from my insurance. What??!! It was fine last time, but not now? I don’t get that, unless someone just wasn’t paying attention. Was there any precedent set with them paying the first time? Any suggestions?
Turnaround
I suggest that you find out their appeals procedure and file an appeal. They also have to tell you the reason they are not covering the sensors. Insurance companies say no whenever they don’t feel like covering something, knowing that the majority of people will never appeal. On appeal, at least you’ll get a fairer bite at the apple. Also, did they cover the purchase of your Dexcom device in the first place? If they covered the device, they certainly should cover the supplies (i.e., the sensors) that the device requires. If they didn’t cover the device originally, then their reason for denying coverage of your sensors is important. Usually, they will say medical necessity is lacking (for which you should respond by getting a letter from your doctor), or they will say the GCM is experimental and not a proven medical technology. Slowly but surely, the insurance companies are gving up on that line as more scientific documentation shows the value of GCMs. Be persistent. If they deny your appeal, ask for a reopening of your claim and reconsideration. If your insurance is from your employer, tell human resources about the problem. My employer put pressure on the insurer who finally agreed to cover my Medtronic GCM. No guarantee, but worth a try.