- advertisement -

Denial of CGM by Blue Cross of Ca.... Don't give up hope!

Discussion in 'Parents of Children with Type 1' started by yelley, Jul 12, 2011.

  1. yelley

    yelley Approved members

    Joined:
    Apr 9, 2010
    Messages:
    74
    I had mentioned before in other posts that my daughter was denied the Dexcom system after they had already shipped it out. That was back in December 2010.

    Of course I appealed that to the insurance company which again they denied stating it was considered "investigational" being that my daughter was under 25 and did not experience enough lows under 50mg.

    I left it alone for awhile and thought that I just didn't want to fight this battle.

    I decided I would give it one last try by contacting The Department of Managed Health Care. I was able to fax over my application for an independant medical review along with the suppoting documents of what had been sent ot the insurance company.

    Yesterday, about 3 weeks later, I received a packet from the Department of Managed Health Care with the outcome of the Independant Medical Review and guess what???

    I WON!!! :D

    The insurance company has 5 days to get this covered on the policy and the best part is the clause that is listed under "Appeal", it states that "Their decision is final an no appeals can be made".
     
  2. keanna's momma

    keanna's momma Approved members

    Joined:
    Jun 22, 2011
    Messages:
    48
    Excellent news!!!
     
  3. iluvmhp

    iluvmhp Approved members

    Joined:
    Mar 10, 2008
    Messages:
    1,582
    Who is the The Department of Managed Health Care? I am working on my final allowed voluntary appeal letter today! BCBS Alabama. They denied saying she did not have enough bs under 50. I sent in documentation showing several and they still denied the second appeal.

    I appreciate you information. Perfect timing!

    Edit - I just googled it. ...I see it is a California specific thing. Oh well.. Great news for you! I will keep trying!

    Susan
     
  4. Tracy1918

    Tracy1918 Approved members

    Joined:
    Apr 14, 2010
    Messages:
    365
    Wow! That rocks!
     
  5. Kaylas mom

    Kaylas mom Approved members

    Joined:
    Apr 14, 2010
    Messages:
    1,306
    Good for you! That is great news!
     
  6. yelley

    yelley Approved members

    Joined:
    Apr 9, 2010
    Messages:
    74
    Can you find something your state may offer that is comparable? Is there anything on a federal level?

    Apparently it is some type of state law because the way I found out about it was from the denial paperwork that Blue Cross sent me. They must have to include it but probably don't think many people will pursue it, I almost didn't.
     
  7. NomadIvy

    NomadIvy Approved members

    Joined:
    May 20, 2010
    Messages:
    1,130
    That is sooo cool. Now I'll have to argue with our endo to prescribe and "fight for" insurance to cover Dex supplies.
     
  8. mommabear

    mommabear Approved members

    Joined:
    Mar 25, 2011
    Messages:
    469
    That is wonderful:D Congrats:D good job on not backing down:cwds:
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice