I am expecting a fight over my planned use of a CGM. I have decent HbA1C (6.3%) and have not had hypo problems but I have trouble staying outside the low 200's BG about 2-4 times per week. My endo and I are convinced a CGM will help me solve this. I am "in the process" of finding out if my private insurer will cover the CGM.
I found a document online that seems to give Oregon based private insurers a rationale for denying coverage of CGM for type 1's, except as listed. Does anyone know if there is new research/data/government health board findings to refute this? This official document seems to contradict things I've read from other type 1's on this forum and the ADA forum. I would like to arm myself with some research findings that support use oof CGM for somebody in my situation.
Anyway, the document was on the Oregon Health Authority letterhead and stated the following:
"HEALTH EVIDENCE REVIEW COMMISSION (HERC)
COVERAGE GUIDANCE: CONTINUOUS GLUCOSE MONITORING IN DIABETES MELLITUS
HERC COVERAGE GUIDANCE
Continuous blood glucose monitoring with real-time or retrospective continuous glucose monitoring systems should only be covered for Type 1 diabetes mellitus patients for whom insulin pump management is being considered, initiated, or utilized and who also have one of the following:
• HbA1c levels greater than 8.0% despite compliance with therapy, or
• a history of recurrent hypoglycemia."