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Have You Been Denied Medicare Coverage for CGM?

By Ava Runge

Taking Control of Your Diabetes (TCOYD) recently announced the launch of its Continuous Glucose Monitor (CGM) Medicare Appeals Assistance Program, made possible by a grant from The Leona M. & Harry B. Helmsley Charitable Trust. The new program will provide appeals assistance to low-income Medicare recipients who have been denied CGM coverage and want to appeal this decision.

Eligibility Criteria

To be considered for TCOYD’s CGM Medicare Appeals Assistance Program, potential participants must meet the following eligibility criteria (from the TCOYD website):

  • Have diabetes requiring multiple daily injections (MDI) or insulin pump therapy with hypoglycemia unawareness (the inability to recognize when blood sugar is too low).

  • Have had private health insurance coverage for CGM before transitioning to Medicare.

  • Have been denied coverage for a CGM by Medicare, filed a request for redetermination (the first level of appeal), and been denied again.

  • Be able to include a copy of the redetermination decision letter from Medicare denying the first level of appeal.

  • Have a physician willing to sign a statement of medical necessity.

  • Have medical records that can be submitted in support of the Medicare appeal if requested.

  • Agree to have their favorable Administrative Law Judge decision shared and added to the administrative record on appeals. The purpose of this request is to send a message to Medicare that this is an important issue and affects many people.

  • Have gross annual pre-tax household income below the median income in your state for a household of the same size.

For more information on the program, including instructions for completing the application, visit the TCOYD website.

About TCOYD

TCOYD is a 501(c)3 non-profit dedicated to educating and motivating people with diabetes to take a more active role in their condition. The organization also provides innovative and integrative continuing diabetes education to medical professionals caring for people with diabetes.

TCOYD has been educating and motivating diabetes communities in cities around the country since 1995 through their conferences aimed at everyone with diabetes. These daylong programs assemble an all-star cast of diabetes experts who work to ignite motivation, offer hope, and ultimately change people’s lives with diabetes forever; TCOYD’s next conference will be on October 1 in San Diego, CA.

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