Continuous Glucose Monitors Medicare Appeals Program Launched

November 6, 2016 09:00 AM PST

Taking Control of Your Diabetes^® (TCOYD), in collaboration with The Leona M. and Harry B. Helmsley Charitable Trust, announces the launch of a Continuous Glucose Monitors (CGMs) Medicare Appeals program. The program was developed in response to the growing number of individuals on Medicare being denied coverage for CGMs.

CGMs have not only been shown to improve quality of life for patients with type 1 diabetes and lower A1Cs to 7% or below, but they also have been proven to reduce the number of severe, life-threatening hypoglycemia events by 32%. This program is a direct attempt to help individuals who need CGM coverage the most.

The program provides financial assistance to low-income Medicare beneficiaries who have been denied coverage of a CGM. Funds will be used for legal support to assist in the appeals process.

"This CGM Medicare Appeals program reaches out to those most in need of coverage who have been denied, with the ultimate goal of universal Medicare coverage for all CGMs. It is so important that those in charge at Medicare know that Type 1 diabetes doesn't go away when you turn 65." - Dr. Steven Edelman, Founder and Director TCOYD

To qualify for the program, individuals must meet the following criteria:

Have diabetes requiring multiple daily injections or insulin pump therapy with hypoglycemia unawareness.
Have been denied coverage for a CGM by Medicare, filed a request of redetermination (first level of appeal) and have been denied again.
Be able to include a copy of the redetermination 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.
Have gross annual pre-tax household income below the median income in your state for a household of the same size.

The lack of coverage of CGMs through Medicare has catastrophic and costly consequences. Separate from this program, TCOYD has a community-wide campaign (#CGMMATTERS) underway focused on securing universal coverage for CGMs under Medicare. To learn more, visit TCOYD.org.

TCOYD is a not-for-profit 501(c) 3 charitable organization dedicated to educating and motivating people with diabetes and their loved ones to take a more active role in their own health and to provide continuing diabetes education to medical professionals to better care for their patients. Learn more here: https://tcoyd.org/index.php/about-us/about-tcoyd.html