United Healthcare Approved my Dexcom G4 system on 7/16/14. Since then, they have been approving my sensors every 90 days. My last covered purchase of sensors was on Jan 9th 2015. I have now reached the 6 month mark and wanted to reorder a transmitter before the battery dies.
I am Type II and My Endocrinologist does not accept any CGM data to make decisions with so I am unable to discuss trends, peeks and lows between finger sticks.
After submitting my request for the replacement transmitter, I received a communication that they denied coverage and I could have my doctor request a peer to peer review to prove I need this.
I asked and I believe my doctor may have followed through given I just received a letter in the mail from United Healthcare indicating coverage is denied.
It says being Type II and my recent records do not show a history of low blood sugars.
1. Why would they cover me and then when requesting a replacement transmitter drop me?
2. I have a general problem of blood glucose levels that are too high, not too low. I was using the Dexcom to help bring my levels down without going low. Now I have to record many low readings to re-qualify?
3. I am wondering if they just decided not to cover the transmitter but will continue to supply the sensors? If I knew they would continue covering the sensors I would probably but the transmitter on my own.
I am wondering what the best strategy is to dispute this and win. I don't know what I would do without this CGM. 4 data points per day just don't cut it. I find that my levels can look fine and then an hour later they are in the low 300's.
I am also wondering if I should switch endocrinologists to one that believes in using this technology. It would help to have someone help fight this for me.