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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.
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Doesn't sound to me like this "board certified physician" is an ENDO!
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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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I agree with Jedi.........they must be talking about the old Guardian. I'd appeal again, Tony, and this time I'd mention to the Medical Director that you'd like him to review your appeal with an Endocrinologist!
Good luck and keep us posted on what you decide to do.
Karen
