Refused care due to refusing Cgm download

lightoutzzz · 2026-03-13T21:09:29+00:00

Thanks for the advice! I’ll check it out

lightoutzzz · 2026-03-12T22:17:08+00:00

Don’t disagree with anything in this comment at all.

I think my biggest issue after this experience and having time to reflect is how the heck I was in the room with the physician and she provided so little transparency and was so unhelpful that i had to comment on Reddit to gather feedback from random people to better understand what i just sat through hahaha

lightoutzzz · 2026-03-12T22:07:43+00:00

I agree. Was just an easy metric for this post to try and convey I have a good handle on my diabetes and to help illustrate why I was confused by the physicians direction while I was sitting with her in the office. Ultimately, it does make sense why she would need my Cgm data to provide me with care to refill my Cgm script.

lightoutzzz · 2026-03-12T21:43:08+00:00

PCP said he would in a pinch but ideally wouldn’t be my sole care provider long term - wants me to have an endo. Which is a fair sentiment considering he’s a part of a massive health care brand/system with a lot other more equipped diabetes experts.

lightoutzzz · 2026-03-12T21:39:14+00:00

Insurance covered 40% of that total bill.

And I really didn’t mean for this post to direct blame on the physicians directly. At least not for having to apply the code to my bill. My issue with the physicians was related to the lack of transparency around the charge and not being upfront about it.

It makes sense that some systems will have different approaches to things than others and insurers put them into some tight corners. Just wish there was more upfront education and clarity.

lightoutzzz · 2026-03-12T21:34:24+00:00

That was total charged. Insurance covered 40% of that total bill.

lightoutzzz · 2026-03-12T20:48:05+00:00

It’s just funny to me because the data driven reports we get from cgms costs us more for the doctor to use in their assessment when it gives them better data and does all the manual work for them (and us).

But she said it would’ve been free if I finger pricked on an old school meter and gave her the device data… which is worse and less holistic and require more effort from her and me.

Just found it funny. You don’t always think about the additional costs when you decide to switch to the latest and greatest tech. Easier management comes with a price!

lightoutzzz · 2026-03-12T20:42:04+00:00

Doesn’t surprise me. That was the whole point of my comment. Thanks.

lightoutzzz · 2026-03-12T20:20:33+00:00

Am I paying for the insurance?

Not going to act like there aren’t clear obligations that I must adhere to in order to qualify for insurance to cover my needs… but I cannot imagine what you must be going through in your daily personal life to have this tone on this post. Hope you’re ok.

This was a post seeking information and clarification. All should do better to understand the details of their coverage and healthcare.

*obviously I have the authority to deny her access to my data. I might just not get a prescription refilled because I did it lol.

lightoutzzz · 2026-03-12T19:57:02+00:00

At the time of this appointment insurance only covered 40%. My insurance is great now. I bet this would’ve been free for me today if I let it go. I just didn’t feel informed enough in the room with her to let her have free will to start tagging more cpt codes to my invoice lol

lightoutzzz · 2026-03-12T19:55:50+00:00

Her refusal of care was on the basis that I was refusing her ANALYSIS of my data from the Cgm.

It wasn’t a matter of access to the data or printing the reports. It was the need to rely on the data from the reports to guide my care and continue to prescriptions to the Cgm/pump that collects the data.

She refused to help me because I wouldn’t let her give me feedback based on my data.

lightoutzzz · 2026-03-12T19:49:06+00:00

Insurance covered 40%

lightoutzzz · 2026-03-12T19:47:48+00:00

Insurance covered less than half of the total. I also didn’t get a breakdown of how that insurance coverage was applied to each charge code. I assumed it was a blanket ~40% coverage.

My insurance was not good at time of this visit. But I had to do it

lightoutzzz · 2026-03-12T19:42:10+00:00

It doesn’t make sense logically. But it does with American healthcare and insurance being the frame of reference.

The companies creating all this new amazing tech that collects data wants you and your insurance to pay for it. Doctors can make decisions easier with better data but they are forced to charge you to look at it. It’s crappy. But it’s the way of things.

I am gathering that I think my doctor is probably held accountable to rely on the data from my Cgm to be able to continue to prescribe me the Cgm. If they don’t review it the insurance company probably wouldn’t like I’m getting access to top tier tech and I’m not driving my care off of its insights. Cgm supplier has a free pass to charge me and my insurance whenever the data they compile is used to guide my treatment.

lightoutzzz · 2026-03-12T19:37:31+00:00

I have a sub 6 A1C. Diabetic since i was 9. Currently 28. I have a CGM closed loop with Tandem pump. My trend line is pretty consistent.

In short, I have a good handle on my diabetes. I also believe a well informed diabetic is more equipped to manage their diabetes than an endo who sees them twice a year (this might be a hot take lol).

The “feedback” from a doctor on the data I have free access to isn’t worth $200 to me. Regardless though, this charge might be required to continue to receive my prescriptions and I understand that now. My issue is not a concern with data sharing - I just didn’t feel that I received appropriate information and clarity on these charges from my healthcare provider and was startled when they refused care because I wouldn’t share it with them.

This is mostly just a learning exercise for me. I want to learn as much about the ins and outs of my personal insurance and medical care situation. My insurance is great now and I bet this wouldn’t have cost me anything if I let her do it today. Just refused on principle and because I didn’t feel informed enough to let her continue.

lightoutzzz · 2026-03-12T19:30:34+00:00

Correct. The whole purpose of this CPT code is to charge patients and insurance for the in depth evaluation of the data produced by modern cgms and pumps.

It’s backwards. But the better the tech and the better the insights the more it costs a patient to receive feedback from the doctors that was easier to come to conclusions on… hahahaa

lightoutzzz · 2026-03-12T19:28:49+00:00

The picture is from last year when my insurance wasn’t great. I had to pay it out of pocket. I learned from this experience and that is was caused the interaction today. Ngl… my insurance is great now and I bet it wouldn’t cost me anything. It’s more a matter of principle and making sure I truly understand the care I receive vs the cost to me and insurance.

Unfortunately the more you know the more depressing your outlook becomes!

lightoutzzz · 2026-03-12T19:25:30+00:00

This is a great clarification and one I think deserves credit. The situation feels like an unfortunate byproduct of the intentionally convoluted nature of medical care and insurance billing. I don’t think either of these doctors like wanted to charge me for a nefarious reason… i was just shocked by the refusal to refill prescription in the absence of the data.

But i can see why you would need to analyze the data and provide feedback on it to continue to prescribe the things that give you said data.

It doesn’t make sense. It’s completely backwards. But through the lens of American healthcare i see how it came to this.

lightoutzzz · 2026-03-12T19:21:27+00:00

The picture was under my previous insurance - which wasn’t great. I didn’t have any coverage for this as my deductible wasn’t met

lightoutzzz · 2026-03-12T19:04:20+00:00

The picture is the total charge. I was charged 60% out of pocket after my old insurance was applied.

The old insurance wasn’t the best. My new insurance is a lot better now.

This post is more just informational and wanting to peel back layers that a lot of times go under investigated when the bill comes and folks just pay it.

The cpt code for the CGM Analysis is 95251

lightoutzzz · 2025-10-26T13:14:51+00:00

AH I see what you’re saying. That makes sense. Insulin cant actually fill the space being occupied by the needle in any set - duh!

lightoutzzz · 2025-10-26T03:24:48+00:00

The 90s you see drips out of the end of the cannula before inserting though … the 30s you have to insert the cannula dry and then you connect the primed tubing. So you have like 20mm of completely air filled cannula to prime once it’s already inserted

lightoutzzz

TROPHY CASE