Want coverage for my CGM

I just recently received my Insulin pump. I am really excited to get started with it. So far I have been going through Medtronics Online Pump School so that I can be prepared for my pump training. I am very happy with my insurance and everything that they cover with my pump and supplies. Now, for those of you with pumps, you know one of the issues currently is the lack of support \ approval of insurance companies to cover CGMS. Unfortunately, I fall into this group as well. I decided to bite the bullet and get the CGMS with my pump. Now that adds and extra $1000.00 for the monitor and an extra $330.00 for every box of 10 sensors. I really can not afford to foot the bill for those sensors. So this is where I need the help.

For those of you with Pumps out there, who have decided to go with a CGMS and have had the fortune of being approved by your insurance, how did you do it? I’m willing to go to whatever extents it takes to get it covered. I just don’t know where to start. Notes from Doctors? Letters? Phone calls? What’s the magic steps to finally get the insurance companies to give in? Any insight that everyone in the OC can give me would be much appreciated.

Once I figure it out, I will be sure to keep everyone up to date and write out a nice detailed post on how I did it. I will not give up until I get it covered.

Hi Chris, Minimed can write you a template letter of medical necessity (I have one I can send you) your endo sends it to the insurance company, then they deny you coverage, then you appeal, and then you (may) get coverage.

BCBS in New Jersey is approving CGM without the first denial - but I think I heard the policy director is Type 1… hey let me know if you want the letter. - Joe

Joe, that would be great. I have quite a bit of info that I have pulled from various post here about what to do once you have been denied coverage. So I am ready for the denial letter. If you could send the medical necessity template. I will message you with my email.



There are some documents in the thread above.

Send me your email addy and I will forward you some documents that you could perhaps use.

I fought 6 months to get mine approved even through an appeal process.

My daughter had hers approved because she had 3 seizures in less than 3 months. 2 of them were 4 days apart. She has Amerigroup insurance which is offered by the state of Florida through a program called Healthy Kids.