Update on my appeal for the CGMS.
The insurance company denied the cgms again even though I meet medical criteria for the CGMS. Their policy guidelines states they only cover two in a calendar year and I'm looking for long term use.
Quote:
Our medical director, a board certified physician, has again reviewed the medical necessity of the services referenced above. Based on the information provided, the services referenced above for the Continuous Glucose Monitoring System (CGMS) continues to be denied.
Reimbursement for services remains denied because although the member does satisfy BCBSRI medical criteria for cgms coverage, his request is for long term continued use of cgms. BCBSRI policy guidelines, limits coverage of this item to two times in any calendar year.
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