I received a deniel letter today from Blue Cross Blue Shield of NC for a CGM device (Continuos Glucose Monitor) for my 5 year old daughter. Reason for denial: Not Medically Necessary. It also says "In this case, records do not indicate the presence of severe, symptomatic hypoglycemia." What is considered severe? Luckily we have been fortunate not to have any major episodes (knock on wood), but she has had her share of highs and lows and will be beginning full day school in the fall.
I am so furious, ready to write my letter of appeal, but I think it would be wise to calm down first and ask for some advice on what appoach to take, rather than say to them what I really want to...
If any one has been approved, can you please give any information that may have helped you to get approved. Any example letters would be greatly appreciated and would also help others going through this same problem.
Thanks for any help!!