Insurance Appeal for Dexcom G6

My insurance company has denied coverage and the 1st appeal for the Dexcom G6 for my 13 yr old son. I have submitted a 2nd appeal that will go through an Independent Review Organization. Does anyone have experience with submitting an appeal to an IRO? I would like to make sure I’ve submitted everything that could ensure a successful appeal.

Has your doctor written a medical necessity letter? On what grounds is the carrier rejecting? Check your pharmacy coverage. I have received notice from both Dexcom and a pump supply house that they are working on getting durable medical equipment approved via RX plans in addition to health insurers.

That’s crazy. If he’s T1, there should be no basis for denial if your Dr wrote a prescription. As per Steve’s answer, I have found I can get my daughters through Medical or Pharmacy, but going through Pharmacy has been both cheaper and easier. In fact, on the new RX plan that we switched to this year our co-pay is $0 (which totally blew me away). Have you tried working with Dexcom to get it resolved? I promise there is a rep out there somewhere that wants to see it taken care of for you.