Patient has commercial insurance?
We got you covered!
Most Commercial Insurance plans require a prior authorization. Once we have the patient’s demographics, insurance information, prescription and medical records, CGM Monitors will initiate the prior authorization.
By following this comprehensive four-step process, CGM Monitors operates to provide prior authorization services efficiently and effectively, ensuring optimal patient care and satisfaction.
Gathering demographic information
To initiate prior authorization, we begin by collecting essential demographic details from the patient. This information includes the full name, date of birth, gender, address, contact information, identification particulars, and marital status.
Requesting medical records
To proceed with the prior authorization, we must access the patient's medical records. This step involves obtaining pertinent documents such as the prescription, primary health provider's information, chart notes, and written orders.
Acquiring insurance information
In this step, we get comprehensive insurance details from the patient. These crucial pieces of information include the name of the patient, date of birth, insurance identification number (ID), as well as the name of the insurance provider.
Initiating prior authorization
With all the necessary information, we initiate the prior authorization process using streamlined procedures. We employ specialized portals designed to send authorization requests. Additionally, we contact with patient's insurance agent, when required.
Medicare Part B does not require any authorization for a continuous glucose monitor.
Medicare covers therapeutic continuous glucose monitors such as the Freestyle Libre 2. There is no prior authorization needed for patient who have Medicare Part B insurance. They do have to meeting the following requirements set by CMS:
- Have a face-to-face visit with the ordering provider within the last 6 months and every 6months.
- Require frequent adjustment of their insulin
- They must inject insulin 3 or more times a day
- Diagnosed with Type 1 or Type 2 diabetes
HMO & PPO
Most HMO and PPO plans require a prior authorization. Once we have the patient’s demographics, insurance information, prescription, and medical records, CGM Monitors will initiate the prior authorization. Some plans may require a authorization be initiated by the ordering provider.
The final decision is made by your insurance company after a prior authorization is initiated and supporting documents are provided to the insurance company.
The requirements for HMO and PPO Plans are as follows:
Patient must be either Type 1 or Type 2 diabetic.
Patient must visit his or her physician within 12 months.
Please note that the patient does not need to frequently adjust insulin dosage. Patient does not have to be insulin department.
If you would like us to initiate the authorization, please have your physician fax a prescription for the CGM reader and sensor, medical records/chart notes and a copy of your insurance to (833) 329-6979/(833) FAX-MY RX.
Your doctor can also send us electronic prescriptions/E-scripts however the medical records/chart notes along with a copy of the insurance card will have to be faxed to us at.
