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Insurance denials

Discussion in 'Parents of Children with Type 1' started by sage68, May 2, 2010.

  1. sage68

    sage68 Approved members

    Feb 25, 2010
    I am just so irritated with my insurance company right now! I am trying to get them to cover a CGMS for both of my girls and they have denied us 3 times. The first 2 times they said it was because they don't cover "convenience devices" but once i proved to them that they aren't for convenience, they retracted that and told me that they don't cover "devices that monitor bodily functions.":eek: What is even more irritating is that we have Kaiser, and in California, CGMS is covered but here in Oregon/Washington it isn't. Our pediatrician is behind this 100% and has written letters to them in support of this, and is even representing us in these appeals but they are still denying us. I am NOT giving up on this but am just so upset about it. I am just getting so tired. I think I get 4-5 hours of sleep a night (and never in 1 chunk) because at least 1 of my girls is low every night, and I am checking them every 2-3 hours. I need to sleep but it isn't an option and of course, insurance doesn't care.

    Sorry. Just needed to vent. I am just fuming over this and decided to write here rather than the appeal letter. I am going to do that tomorrow night after I cool off a bit.:eek:
  2. 2type1s

    2type1s Approved members

    Nov 23, 2008
    Have you tried doing a Dexcom trial? The insurance required this with Morgan, and we sent the numbers off. The trial proved the wide swings, and general safety issues. Now with Zoe, they approved it right away, didn't even ask questions (they got it 2 months apart!). Morgan's A1c dropped a whole point in 48 days that she was on it. That's proof enough for me!
  3. Gracie'sMom

    Gracie'sMom Approved members

    Aug 26, 2009
    The CGM is great, but just to clarify that for most of us we don't really sleep more with it. It does give you peace of mind, but you also do more correcting because you really know what the numbers are. We still get up 2-6 times per night, depending on how things are going . . . Keep fighting, you'll get it covered. Having 2 with D, it will be even more helpful to you in managing their #'s. Good luck!!!
  4. Mom2rh

    Mom2rh Approved members

    Mar 15, 2006
    Why not get approval for a two week trial first. Then based on what you find out then, maybe you will have some ammunition for the approval you want.
  5. Wendyb

    Wendyb Approved members

    Nov 6, 2007
    Yes---I agree with you. Your girls are quite young and I think insurance should cover this for you. What I would suggest is joining the CGMS yahoo group that several of us on CWD belong to. In the files section of the group, others have posted their letters to insurance companies for you to model your best letter after. I have sucessfully had two different BCBS companies approve both the integrated and the Guardian units and we now have both. However, currently I am trying to get our latest insurance company to cover the sensors. Who knew they would see these as somehow unrelated to the device they approved.

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