If you have diabetes and your doctor has prescribed a continuous glucose monitor (CGM), it can be extremely discouraging to receive a continuous glucose monitor insurance claim denial. A continuous glucose monitor is a device that accurately displays your blood glucose level, or blood sugar, throughout the day and night. According to NCBI, CGM use rose from 0.4 percent in 2014 to 4.1 percent in 2020. In the last four years, the use of CGMs has increased even more—and probably would be much higher if all insurers paid for the CGMs.
A continuous glucose monitor has a tiny sensor that is inserted under the skin, usually on the belly or arm with a sticky patch that helps it stay put. This is known as a disposable sensor and usually lasts from 10 to 14 days before you replace it. Some sensors like the Dexcom G6 and G7 send the information directly to your phone via Bluetooth and have a transmitter, while the Libre 14-day must be physically scanned with the NFC chip reader on your phone.
While you can scan as often as you choose, you must scan this type of CGM at least every eight hours or you will lose some readings. You must have a compatible software program on your phone, or, in some cases, the information is stored on a separate receiver or an insulin pump. When you can see your blood glucose levels in real-time, you are likely to make more informed decisions regarding the food and beverages you consume, as well as the physical activities you engage in. There is generally a “target range” that you will try to stay within when you wear a CGM.
When you stay within this target range you can often prevent other health problems that can be caused by diabetes. Unfortunately, many insurance companies refuse to pay for CGM monitors unless you have Type 1 diabetes. Some will pay for CGM monitors for those with diagnosed Type II diabetes, but virtually none will pay for those with pre-diabetes, even though the CGM can conceivably prevent pre-diabetes from turning into Type II diabetes.
Overview of Glucose Monitors and Sensors
The following are the primary types of glucose monitors and sensors (CGMs):
- Dexcom was formed in 1999 and was the second firm to have a CGM approved by the FDA in 2006. Dexcom started with the G5, but today they market the G6 and the G7 models, both of which are FDA-approved for adults and children as young as 2. Dexcom models are known as “real-time” CGMs which means they automatically update on your smartphone app or compatible insulin pump every five minutes.
- Abbott manufactures the FreeStyle Libre 14-day, the FreeStyle Libre 2, and the FreeStyle Libre 3 CGM systems. The FreeStyle Libre 2 and 3 are FDA-approved for adults and children over 4 years old. The Libre 14-day system is only for adults 18 years old and older. Both Dexcom and FreeStyle CGMs have a warm-up period from 30 minutes to two hours—the FreeStyle systems each take one hour, while the Dexcom G6 takes 2 hours and the G7 takes 30 minutes. Libre 3 is a real-time CGM that sends readings to your phone app every minute. Libre 14-day and Libre 2 must be scanned with the NFC chip in your phone.
Certain CGMs are compatible with insulin pumps; The Dexcom G6 is compatible with Omnipod 5, iLet Bionic Pancreas, and Tandem t:slim x2. The Dexcom G7 is not compatible with the Omnipod but is compatible with the iLet and the Tandem. The only Freestyle CGM that is compatible with an insulin pump is the Libre 2, which is compatible with the Tandem t:slim x 2.
- Eversense, manufactured by Senseonics is the most recent CGM brand; in 2018, the FDA approved the 90-day implanted CGM from Eversense.
- Medtronic was the first organization to receive FDA certification for CGM devices in 2001 and now manufactures the Medtronic Guardian Device.
- Fiasp is a fast-acting mealtime insulin that improves glycemic control in adults with Type 1 and Type II diabetes.
- Diabetic drugs like Ozempic (semiglutide) and Mounjaro (tirzepatide) are longer-acting GLP-1 agonists that are injected weekly and are associated with greater weight loss than shorter-acting GLP-1 agonists such as Saxenda (liraglutide).
What Should You Do Following a Continuous Glucose Monitor Insurance Claim Denial?
Because CGMs can be expensive (from $300-$500 per month), many insurance companies will deny a claim for them, stating they are not medically necessary, particularly for those with pre-diabetes and Type II diabetes. Even though these devices can help people with pre-diabetes or Type II diabetes control their blood glucose levels, insurance companies are notorious for refusing to pay for preventative measures. If you have received a continuous glucose monitor insurance claim denial, you have the right to file an internal appeal as well as an external appeal if the internal appeal is unsuccessful. Having a letter from your doctor that details all the benefits you would receive from a CGM device can help get a denial reversed.
What Insurance Companies Are Most Likely to Deny CGM Monitors?
While any insurance company can issue a continuous glucose monitor insurance claim denial, some insurers are more likely than others to do so, including the following:
- Anthem Blue Cross
- Blue Shield
- HealthNet
- Kaiser
- UnitedHealthcare
- Aetna
- and others
How the Law Offices of Scott Glovsky Can Help Following a CGM Denial
Following a continuous glucose monitor insurance claim denial, you need a strong legal advocate in your corner. That advocate is attorney Scott Glovsky and the experienced legal team at the Law Offices of Scott Glovsky. Scott never hesitates to take on a big insurance company and has many successes to his credit. While big insurers may think they are untouchable, Scott will always step in to make a positive difference in your health and your future. Having someone fight for justice on your behalf can change everything. You will get the medical treatments you need and deserve and your future will instantly look brighter when you are given hope for the future. Don’t wait—contact the Law Offices of Scott Glovsky today.