I see this thread is 6 months old but it has some significance to what I experienced today so I thought I would reply, better late than never, right? I have been waiting for weeks to find out if my insurance company was going to approve a pump and a CGM. I found out today that they approved the pump but denied the CGM because I haven’t had severe enough hypos, which seems ridiculous to me. I would like to see their criteria, or have them give me a reason why they even have criteria for T1 patients besides saving some coin. It seems like they would save money in the long run by just approving it so their patients can better manage their diabetes and have less (expensive) complications in the future.
I am going to talk to my Endo & pump specialist on Monday to see about appealing this decision. If my insurance company still denies it then I might try contacting Dexcom directly to see if they have some kind of cost reduction plan. Worst case scenario I just pony up the cash to pay for the whole thing myself.
Though, unlike your experience, my insurance had no problem covering a glucagon kit.
Has anyone else had this problem with insurance denying your CGM request? If so, what did you do?