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Glucose Monitor denials: what the review data shows
Independent reviewers have decided 100 published cases where an insurer denied Glucose Monitor — and they overturned the insurer 76% of the time. A denial for Glucose Monitor is a starting position, not a final answer.
Published decisions
100
2001–2026
Overturned
76%
76 denials reversed
Conditions behind glucose monitor denials
What insurers denied — and how those fights ended.
| Category | Decisions | Overturned |
|---|---|---|
| Diabetes | 84 | 76.2% |
| Hypoglycemia | 9 | 77.8% |
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 91 | 75.8% |
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 9 | 77.8% |
Typical time to a decision
12 days
Most land between 5 and 21 days
Handled as urgent
47%
Expedited when a delay would cause harm
Recent direction
Falling
93.1% → 69% overturned, last three years
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Findings: The physician reviewer found that An enrollee has requested authorization and coverage for Dexcom G6 continuous glucose monitor system (including sensors, transmitters, and receiver). In this case, notes report diagnoses of hypoglycemia and Raynaud’s disease. The patient does not have diabetes. In an application for independent medical review, the patient reports having to test glucose levels using finger sticks several times daily. The patient reports that the use of finger sticks is challenging as Raynaud’s disease causes the patient's fingers to lack daily blood flow. The patient reports a history of dangerous hypoglycemia levels leading to a loss of consciousness. Hypoglycemia may occur in patients without diabetes due to multiple causes and is dangerous condition.
Nature of Statutory Criteria/Case Summary: The patient has requested authorization and coverage for FreeStyle Libre continuous glucose monitoring system (CGMS) and sensors, and brand name Crestor 20 mg tablets. The records provided for review document that this patient has poorly controlled diabetes, with a hemoglobin A1C of 11.6%. The patient has refused treatment with oral agents, citing allergies to oral medications metformin and sulfa antibiotics. The patient reports that she is unable to do finger sticks and she has requested FreeStyle Libre CGMS for monitoring her glucose levels. The FreeStyle Libre System is a wireless method for self-monitoring of glycemic control, which uses a sensor for monitoring interstitial fluid glucose. Per the U.S.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
Findings: The physician reviewer found that The patient has requested authorization and coverage for an insulin pump. Insulin pumps can be considered for the treatment of patients with type 2 diabetes who are on multiple daily insulin doses or have other types of diabetes resulting in insulin deficiency. Insulin pumps deliver rapid-acting insulin to patients throughout the day to help manage their blood glucose levels. Managing diabetes with an insulin pump may provide better glycemic and metabolic control to patients by reducing hemoglobin A1c, glycemic variation, and hypoglycemia. According to the American Diabetes Association (ADA), the use of an insulin pump requires a commitment by the patient to use the pump safely. The ADA asserts that an insulin pump does not eliminate the need to check blood glucose or provide insulin before meals.
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for one additional Dexcom G6 sensor, totaling four sensors per month. Blood glucose monitoring is essential to diabetes management. In this case, the patient is using the OmniPod 5 insulin pump, which has the capability of communicating with the patient’s DexCom G6 continuous glucose monitor (CGM). The patient has been using this closed-loop pump for several years. The patient is requesting an additional DexCom sensor every month, for a total of four per month, citing concern about potential skin irritation that could become infected by changing sensors every 10 days rather than every seven days.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Glucose Monitorwhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.