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Taking Control Of Your Diabetes (TCOYD) CGM Medicare Appeals Assistance Program

TCOYD has received a grant from The Leona M. & Harry B. Helmsley Charitable Trust to enable TCOYD to assist in the appeals process of low-income Medicare beneficiaries who have been denied coverage for a continuous glucose monitoring (CGM) system by Medicare.

 

Eligibility Criteria

To be considered for this program, applicants must:

  1. Have diabetes requiring multiple daily injections or insulin pump therapy with hypoglycemia unawareness (the inability to recognize when your blood sugar is too low).
  2. Have Medicare Part B or Medicare Part C coverage.
  3. Have been denied coverage for a CGM by Medicare, filed a request for redetermination (the first level of appeal), and been denied again.
  4. Be able to include a copy of the redetermination decision letter from Medicare denying the first level of appeal.
  5. Have a physician willing to sign a statement of medical necessity
  6. Have medical records that can be submitted in support of the Medicare appeal if requested.
  7. Agree to have their favorable Administrative Law Judge decision shared and added to the administrative record on appeals.
  8. Have gross annual pre-tax household income below the median income in your state for a household of the same size.
  9. Details:

    The application must be completed in its entirety. Please send the application and a copy of your Medicare denial by mail or email to:

    Mail:

    TCOYD Medicare Appeals Program
    1110 Camino Del Mar, Suite B
    Del Mar, CA 92014

    Email:

    This email address is being protected from spambots. You need JavaScript enabled to view it.

    Applications will be evaluated on a first come, first serve basis. All applications received will be acknowledged. Applicants determined by TCOYD to be eligible for assistance will be notified by phone.

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