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.

Once we have the prescription and the medical records, CGM Monitors will contact the patient’s insurance company and initiate a prior authorization request.

Prior authorization can be used to discourse the need for further clinical patient information. Online adjudication of prescriptions by health plans and prescription benefit management companies (PBMs) has made it more comfortable to administer the DME benefit. However, the information for DME coverage decisions is not always accessible via the online adjudication system. The claims adjudication process does not transmit data such as a patient's clinical diagnosis and weight, height, laboratory results, non-drug therapy, or over-the-counter medication usage. We can obtain additional information through the prior authorization process. The data is then compared to designated plan coverage guidelines to specify if they can provide coverage.

There are working with almost all insurance companies like:

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