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

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!!!

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".

 

Excellent news!!!

 

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

 

Wow! That rocks!

 

Good for you! That is great news!

 

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.

 

That is sooo cool. Now I'll have to argue with our endo to prescribe and "fight for" insurance to cover Dex supplies.

 

That is wonderful Congrats good job on not backing down:cwds: