BCBS unequivocally told me they do not require chart notes. This the suppliers policy. And they maintain all the records required to determine eligibility
When I place an order, my supplier will ship them on the first they can, right away if it’s been longer than 90 days from the previous shipment.
I have no problem w/insurance preventing fraud and abuse. Requiring chart notes is overkill. A statement from the doctor that this is necessary and that I have seen them in the required time range should be sufficient. MC may require chart notes, but BCBS does not.
This is one of the hidden costs of our unwell health system in the US. Our family doctor in the 50s-60s had no staff. Today doctors, dentists and medical facilities are drowning in paperwork.
Someone saying something isn’t the same as reading the requirements or the contract BCBS [your state] has with the supplier but I’d run with it.
If you call your supplier do they still say they are waiting on chart notes? If they are you can call BCBS [your state] and say your supplier is withholding your supplies and would the agent be willing to do a conference call with you and the supplier. Let the insurance company tell the supplier the supplier is wrong.
2 things to keep in mind
Insurance company representative are human and can be wrong.
Next time Solara’s system says it needs new chart notes you are going to have to go through all this again because the BCBS [your state] requirements or your plan may have changed.
You are absolutely correct. I went through the messaging system from my BCBS account. At some point, each message got an auto-reply that the forwarded my question to a specialist (or something like that). I have not idea who that was or what department. By unequivocal, I mean that I reiterated the question to make sure we were talking about the same thing and they confirmed. I even told them that the supplier claimed it was. I realize that doesn’t mean it is correct. Your previous reply is a case in point.
I did ask the supplier if this is indeed a requirement by the insurer and if they could provide me with the relative section and or language from BCBS. I haven’t heard back yet. And I may not.
The expy date for my chart notes was Sept 15. I had my doc send them the current chart notes before I placed my order. They (seemed to) confirm that it was in order. So I don’t there will be a problem this time. And I intent is to provide them with whatever they say they need to fill my orders while I convince to take a specific statement from my doc as opposed to the chart notes. Long shot I know, but that my goal.
The one thing I have thought of that might get the DME companies to change their practices is if the US Department of Health and Human Services tells them to. HHS enforces HIPAA. Under the laws that make up HIPPA Solara is a Health Care Provider and subject to HIPAA. The HIPAA Privacy Rule says “A covered entity must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request.” 45 C.F.R. §§ 164.502(b) and 164.514 (d)
As relates to Medicare, the requirement for documented proof for the continual supply of durable medical equipment is necessary to prevent fraud and that the DME is actually required by the patient.
With our use of pumps and CGMs it is probably more annoying for this requirement as we need supplies every 90 days. Whereas a wheelchair is more of a one time thing.
Thinking of the DME companies as a vendor is, in my opinion, rather short sighted. The DMEs are more like a pharmacy for durable equipment instead of drugs.
I am assuming that DME companies are under the same HIPAA privacy requirements as doctors, nurses, hospitals and pharmacies.
Personally I don’t give a rat’s arse as long as I get my supplies. I have enough of a public presence of the fact that I have diabetes and use a CGM and pump on the internet, that this just doesn’t concern me.
Solara has a reputation for holding up a shipment when they do have the required documentation. They must be an administration nightmare.
As to other insurance companies, I am sure that they want accurate accounting for the need for DMEs.
I have had delays waiting on Endo notes in the past, I remember having to go through my BG meter’s memory and wrting down all my tests for 2 weeks on paper and giving that to my Endo for her notes.
But things have gotten much simpler since I began to use my CGM device (Dexcom G6 right now). I have regular video appointments with my Endo, and before each, I upload my CGM data to Clarity and authorize Clarity to make that data available to my doctor for her notes. This makes things easier both for me and for my Endo’s office.
i care a lot about data privacy, especially medical data, but will relax my concerns if that impacts my health.
I do agree the US sysem is crazy. But fraud really does exist. Thank you, spdif for posting the link about the $1.2 billion fraud case. I have personally seen it on a small scale. Before CGM, I got BG meter test strips by Rx. One time while sick I was testing often and about to run out. I bought some on eBay and the seller lived nearby. We agreed to meet in a public place. I learned her son was diabetic but did not test much so they sold the test strips for money. It finally seemed obvious why insurance wants some proof the patient not only needs but is using the product.
