Sample Request for CGM Insurance Coverage


By: Kristin Lund

We recently published an article about how you can avoid losing money in insurance claims. The article gave helpful hints on how to deal with your insurance company including an sample appeals letter. We promised to publish in the near future a sample CGM appeals letter. Here they are!

Diabetes Health greatly appreciates the assistance of Maimonides Infants & Children’s Hospital of Brooklyn and DexCom in sharing the letters they have successfully used. 

The CMN/LMN* for the sensor usually needs to come from the clinician’s office.  However, patients are more than welcome to adapt them to meet their needs, especially when a glucose sensor has been denied and is in the appeals process.

*A Certificate of Medical Necessity(CMN) / Letter of Medical Necessity(LMN) is a bit longer than a script but basically orders the equipment for the patient. It has some clinical data in it such as BG range, HbA1c’s, therapy, presence of complications, why the sensor is needed, and is signed by the prescribing practitioner.

Real-Time Continuous Glucose Monitoring System letter

Medtronic MiniMed Guardian Real-Time Continuous Glucose Monitoring System letter



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