I'm writing my first appeal letter for a CGM that was denied.
This is what the insurance company said:
"The requested monitor is neither:
appropriate to prevent, diagnose, or treat your condition, illness, or injury: nor it it
consistent with standards of good medical practice in the United States.
I plan to counter the section about CGM not included in the standards of car (is that what they are saying?) by citing research articles showing the benefit of a CGM for T1 diabetes and stating that standards of care are developed based on a body of science showing the benefit of each standard. It takes a great deal of time and funds to develop this body of science.
But how and who actually determines the Standards of Care for Type 1 diabetes?