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Get the free BCBSVT/TVHP Blood Glucose Meter Form

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This document outlines the step therapy guidelines for prescribing blood glucose strips through Blue Cross Blue Shield of Vermont and The Vermont Health Plan.
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How to fill out BCBSVT/TVHP Blood Glucose Meter Form

01
Obtain the BCBSVT/TVHP Blood Glucose Meter Form from your healthcare provider or download it from the official website.
02
Fill in your personal information, including your name, date of birth, and insurance information.
03
Provide details about your medical condition and why you need a blood glucose meter.
04
Include the prescribing physician's information, such as their name, contact details, and signature.
05
Review the completed form for accuracy and completeness.
06
Submit the form to your insurance provider for processing.

Who needs BCBSVT/TVHP Blood Glucose Meter Form?

01
Patients with diabetes who require regular monitoring of their blood glucose levels.
02
Individuals who have been prescribed a blood glucose meter by their healthcare provider.
03
Anyone seeking insurance coverage for a blood glucose meter through BCBSVT/TVHP.
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Our Office Location and Mailing Address We are located at 445 Industrial Lane, Berlin, Vermont.
Finding a Local Vermont provider To find a BCBSVT provider visit use or our tool or call the number listed on the back of your ID card. (800) 810-BLUE (2583). If you, or your dependents, live outside of the Vermont service area, you do not need to select a .
Effective July 1, 2021, Vermont Blue Rx will continue to offer all the same services and benefits that members and providers have had over the years. Pharmacy claims will be administered through OptumRx®, our new PBM administrator.

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The BCBSVT/TVHP Blood Glucose Meter Form is a document used to request coverage for blood glucose meters and related supplies from Blue Cross Blue Shield of Vermont (BCBSVT) or the Vermont Health Plan (TVHP).
Patients who require a blood glucose meter for diabetes management and wish to have it covered by their insurance must file the BCBSVT/TVHP Blood Glucose Meter Form.
To fill out the BCBSVT/TVHP Blood Glucose Meter Form, individuals must provide personal information, details about their medical condition, the type of meter requested, and any necessary supporting documentation from their healthcare provider.
The purpose of the BCBSVT/TVHP Blood Glucose Meter Form is to facilitate the approval and insurance coverage for blood glucose meters and supplies, ensuring patients with diabetes can effectively manage their condition.
The information that must be reported on the BCBSVT/TVHP Blood Glucose Meter Form includes the patient's insurance information, medical history related to diabetes, details about the prescribed glucose meter, and any relevant physician's recommendations.
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