This information is for educational purposes only and is not medical advice. For those navigating the complexities of healthcare coverage, having an insurance prior auth checklist can be essential. Always consult your healthcare provider about your specific medical needs.
Getting your diabetes supplies covered by insurance doesn’t have to be complicated. Our comprehensive insurance prior auth checklist makes the process easier to understand and manage. Whether you’re seeking coverage for a CGM system or other diabetes supplies, this guide will help you gather everything you need.
Understanding Insurance Prior Authorization
Prior authorization (often called ‘prior auth’) is when your insurance company needs to approve a medical device or medication before they’ll cover it. Think of it like getting permission before making a big purchase.Prior authorization helps ensure your diabetes supplies will be covered by insurance before you get them, preventing unexpected bills.
Your Insurance Prior Auth Checklist
Download and print this checklist to keep track of each step:- Basic Information Required:
- Your full name and date of birth
- Insurance ID number
- Medicare number (if applicable)
- Your doctor’s name and contact information
- Your pharmacy information
- Medical Documentation:
- Recent A1C test results (within last 6 months)
- Blood glucose testing records
- Current diabetes medication list
- History of diabetes diagnosis
- Doctor’s Documentation:
- Letter of medical necessity
- Prescription for requested supplies
- Clinical notes from recent visits
- Documentation of failed alternatives (if applicable)
Keep copies of everything you submit. Create a folder specifically for your insurance prior auth paperwork.
Medicare-Specific Requirements
As of January 2025, Medicare requires the following for CGM coverage:
- Diabetes diagnosis (Type 1 or Type 2)
- Testing blood sugar 4+ times daily
- Insulin treatment with multiple daily injections or pump
- Regular diabetes management visits with your doctor
Common Prior Authorization Challenges
Here are typical hurdles seniors face and how to overcome them:- Missing documentation: Keep a complete file ready
- Expired test results: Schedule regular A1C tests
- Incomplete forms: Use our checklist to verify everything
- Delayed responses: Follow up weekly
Next Steps After Submission
- Mark your calendar for 5-7 business days after submission
- Call your insurance if you haven’t heard back
- Keep a log of all communication (who, when, what was said)
- Ask for specific reasons if denied
References
Download our printable insurance prior auth checklist to keep track of your progress and ensure nothing is missed.
Last updated: January 2025
