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Re: [IP] CGMS Denial Info--Susan's question

At 02:36 PM 7/6/2008, DAVID HANCOCK wrote:
>Since you don't meet the criteria the answer would be "no." Since it
>sounds like you are in good control I doubt doing a peer to peer
>would overturn the decision either. In this case the physician
>reviewer would probably consider CGMS a "convenience" item and those
>are never covered.

Interestingly, there was a list for "medical necessity" for getting 
an insulin pump.  One regarded an A1c over a certain amount (I don't 
remember exactly the number now).  My endo told me I would not get 
approved for a pump since my A1c at the time was always in the 
5-range.  However, I could go from a bg of 300 to 30 and back again 
in a matter of an hour or less.  I was approved for my pump by my 
insurance company with no questions asked.

My point is... always go for approval even if you think your 
insurance may not approve it.

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