A Diabetes Educator’s Guide to Protecting Access to Care
For people living with diabetes, the end of the year isn’t just about holidays — it’s often the most challenging time to access care. Insurance plan year changes, prior authorizations, formulary updates, and staffing shortages collide in December, creating delays and denials that can put insulin, continuous glucose monitors (CGMs), and insulin pump supplies at risk.
In Part 1, we focused on proactive steps to secure refills, protect device supplies, and use benefits wisely before the year ends. Part 2 addresses what happens when things don’t go smoothly — when insurance denies a refill, coverage suddenly changes, or you’re told to “wait” during the busiest healthcare month of the year. Chances are that this is rare (insert sarcasm), but it’s good to be prepared.
Written from a diabetes educator’s perspective, this guide walks you through responding to insurance denials, communicating clearly with your healthcare team, and advocating for uninterrupted diabetes care as you prepare for the new year.
When Insurance Throws a Curveball: How to Respond to Denials
December is famous for insurance disruptions that directly impact diabetes management, including:
- “Plan year” insurance changes
- Insulin formulary switches
- CGM prior authorization renewals
- Quantity limits tightening
- Surprise increases in out-of-pocket (OOP) costs
When this happens, it’s easy to panic — but a structured response is far more effective. Follow this step-by-step approach to address diabetes insurance denials efficiently.
Step 1: Call Your Insurance Company
Ask a direct, specific question:
“Can you tell me exactly why this was denied?”
Step 2: Clarify the Denial Category
Ask whether the issue is related to:
- Prior authorization (PA)
- Step therapy requirements
- Formulary or plan-year changes
- Incorrect pharmacy or DME supplier
- Required provider intervention
Knowing the exact reason prevents delays and miscommunication.
Step 3: Message Your Clinic Using Exact Language
Relay the exact wording that the insurance provided. This allows your healthcare team to respond faster and submit the correct documentation.
Step 4: Request a Bridge Supply if You’re at Risk
If you’re close to running out of insulin or supplies, ask about a temporary or emergency supply while the issue is resolved.
Mini-Script for Your Provider:
“My refill was denied due to a prior authorization. Can you submit a PA today? I’m at risk of running out, and insurance recommended the clinic contact them directly.”
Clinics move faster when patients bring clear, accurate information.
How to Communicate With Your Clinic (So They Can Help Faster)
Healthcare offices often operate with reduced staff during the holidays. Clear communication can significantly speed up diabetes prescription refills and insurance approvals.
When contacting your clinic, always include:
- Medication or device name
- Dose or quantity
- Pharmacy or DME company
- Urgency (e.g., “I have 4 days left”)
- Any insurance-related details (plan change, PA requirement, formulary update)
This approach reduces unnecessary back-and-forth and shortens response time.
Mini-Script:
“I’m requesting a refill for Humalog U-100; I take 50 units a day. I use CVS on Main Street. I’m down to 5 days of insulin. Please let me know if you need any additional information.”
Clear. Concise. Effective.
Ask for What You Actually Need (You Deserve That)
Many people with diabetes minimize their needs because they don’t want to be perceived as difficult. December is not the time for that.
Advocacy means asking for what ensures safe, uninterrupted diabetes care, including:
- Updated prescriptions
- Extra insulin, CGM sensors, or pump supplies
- Temporary insurance overrides
- 90-day prescription fills
- Pump setting reviews
- Replacement devices if yours is malfunctioning
Mini-Script:
“I want to make sure I’m set going into January. Could we switch my refills to 90-day supplies to help avoid any gaps in care?”
Small requests now can prevent major disruptions later.
This should be a no-brainer, but “please” and “thank you” go a long way. I’ve worked in telephonic care, and it’s a challenging role. Being pleasant helps build rapport and can make problem-solving much smoother.
Closing: Start the New Year From a Place of Strength, Not Survival
Diabetes doesn’t take a holiday break — and you shouldn’t have to scramble for care because the system is overwhelmed.
Advocacy doesn’t mean being pushy.
It means being prepared, communicating clearly, and knowing the right questions to ask.
If you take nothing else from this guide, remember this:
“My care matters. My access matters. And I deserve timely, uninterrupted diabetes treatment.”
That belief is the foundation of every refill request, every insurance call, and every advocacy action you take this month.
You’ve got this — and I’m cheering for you.
If you liked parts one and two, you can download my Year-End Diabetes Advocacy Checklist.