Patient has commercial insurance?
We got you covered!
Most commercial insurance plans require prior authorization. To start this process, we need the patient’s demographics, insurance details, prescription, and medical records. Once we have these, CGM Monitors will handle the prior authorization.
By adhering to this comprehensive four-step process, CGM Monitors ensures efficient and effective prior authorization services, aiming for optimal patient care and satisfaction.
Acquiring insurance information
At this stage, we gather comprehensive insurance information from the patient. Key details required include the patient’s name, date of birth, insurance ID number, and the insurance provider’s name.
Initiating prior authorization
With all necessary information, we proceed with initiating prior authorization using streamlined processes. We utilize specialized portals to send authorization requests and contact the patient’s insurance agent if needed.
Gathering demographic information
To begin the prior authorization, we first collect essential demographic information from the patient. This includes full name, date of birth, gender, address, contact details, identification number, and marital status.
Requesting medical records
The next step involves obtaining the patient’s medical records. We need relevant documents such as the prescription, primary healthcare provider’s details, chart notes, and written orders to proceed with prior authorization.
Medicare Part B does not require prior authorization for a continuous glucose monitor
Medicare covers therapeutic continuous glucose monitors like the Freestyle Libre 2 without requiring prior authorization for patients with Medicare Part B. However, patients must meet the following CMS requirements:
- Have a face-to-face visit with the ordering provider within the last 6 months and every 6 months thereafter..
- 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 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 the ordering provider to start the authorization process.
The final decision is made by your insurance company after prior authorization is initiated and supporting documents are provided.
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.
Frequent insulin dosage adjustments are not required, and the patient does not need to be insulin-dependent.
Alternatively, your doctor can send us electronic prescriptions/E-scripts; however, the medical records/chart notes and a copy of the insurance card must be faxed to us.