Criteria for Medicare coverage of CGM announced


#166

Since the Medicare rules changed for the second time in 2017, the Dexcom CGM supplies are only available through Dexcom. After the initial order, which took a lot of back and forth between Dexcom and the doctor, Dexcom sends this email once a month:

_In order to successfully receive Medicare reimbursement for the Dexcom G5 Continuous Glucose Monitoring (CGM) System, we are required to reach out to you on a monthly basis to verify your information. Please verify your product usage and refill needs in the link below in order to fulfill your next Medicare supplies order. _

If you do not verify your supply needs and information, you will not receive your next Medicare supplies shipment. Should you have any immediate questions about the Dexcom G5 Continuous Glucose Monitoring (CGM) System, please call 1-888-738-3646.

Please Note: The beneficiary may NOT use their phone or smart device for display of Continuous Glucose Monitoring (CGM) data and still be eligible for reimbursement by Medicare for Therapeutic CGM._

Thank you,
Preformatted textDexcom Team

I fill out the quantity I have of the various items. In order to get a shipment of 5 sensors, I need to have none left; the one I am using is the last one. Even if it takes Dexcom only a day to process the order, it takes a few days to receive the shipment. If there is a weekend during that time, it is very possible/probable for the items to arrive on the last day of the 7 day sensor period, or later. That is a dangerous way of doing this. When Medicare did not cover the Dexcom CGM, my retirement supplementary coverage paid for everything and I was able to get more than 5 sensors at a time and order far enough in advance to receive the shipment before the last sensor’s 7 day run.


#167

Kim, Thank you for your encouraging words! I’m so sorry to read that you have been denied coverage for a G5 CGM. I think you should do what we had to do is contact Medicare, and request that you would like to speak to an Ombudsman, and inquire why you are being denied coverage under Medicare. Your doctor may need to furnish CMS with the additional paperwork requirements they are requiring to obtain the G5. This whole fiasco has been very taxing, and stressful for some folks more so than for some others on Medicare. Fortunately, my wife received her initial G5 CGM package in mid August. Since then we even have ordered a second set of supplies, i.e. sensors, & test strips, but not without some more hurdles to jump over.

There still was an additional paperwork requirement imposed on my wife by Dexcom in continuing to ask for additional duplicate chart notes from her doctor which were faxed to Dexcom TWICE! However, Dexcom is NOT very good about receiving documents, or getting them into the hands of the people that need this so called documentation as per CMS requirements. Dexcom not only has frustrated us, but they have also frustrated my wife’s doctor, and her staff by sending them duplicate information. Her Endo had to call Dexcom to specifically ask them what documents they still needed that they claim they didn’t receive.

For these reasons, this is why I say Dexcom IMHO is still the worst medical supplier that we have ever dealt with because their administrative ordering department doesn’t happen to know what the right hand, or left hand is doing especially in our dealings with them. Others like yourself may not have run into these road block obstacles like we have! Dexcom certainly may have the best CGM device on the market, but the same can not be said for their administrative operations. Just like this email my wife received last month:

Sent: Wed, Oct 11, 2017 07:53 PM

Dexcom Continuous Glucose Monitoring (CGM) System
Dear Nancy,

You’re almost there! We are ready to place your supplies order, but we still need more information from you. We have attempted to reach you, but were unsuccessful.

To help us finish your order, please call us directly at 877-339-2664.

Thank you,
Dexcom Team

This was a HUGE LIE!, as they NEVER tried to contact us, and our home phone still works because we get daily calls from telemarketer scammers even on weekends without trouble! We feel Dexcom has a long way to go in the communications area because for an email that starts out with “You’re Almost there!” can tend to alienate a customer rather than bringing them over to their side. JMHO!

I wish you all the best in trying to get a G5 CGM as I feel you SHOULD be entitled to receive with Medicare picking up 80% of the cost. Remember to contact Medicare @ 800-633-4227 and ask for the Advanced Resolution Center.

Jim


#168

The fix for that is to run at least a couple of sensors for more than 7 days each. That’s what we do and have enough sensors to get us through the period of time that exceeds the 30-day interval between shipments.

Dexcom told me in no uncertain terms to always claim ZERO supplies on hand when I get the email from them for me to confirm quantities on hand. PLAY THE GAME! It makes no sense to be shooting yourself in the foot by actually waiting until you have zero on hand. Always keep a stash of everything diabetic (or all meds for that matter): insulin, sets, reservoirs, sensors, etc.


#169

My blogpost today shares the stories of 6 Medicare beneficiaries who have been helped tremendously by Medicare coverage of CGM. I can still be grouchy about not being able to use my phone, Apple Watch, and Tandem X2 pump. But I am grateful for coverage of my Dexcom G5. After using a CGM for about 9 years, I can’t imagine going without one.


#170

I’ve got about 2 months of CGM wear, and I already can’t imagine going without it! :slight_smile: It’s so much more accurate than I expected.


#171

Great reporting, @Laddie! CGM use combined with my attention to what it tells me has definitely changed my life for the better. That was eight years ago last month for me. Now I use the Dex G4 + Share kit to run my Loop auto-insulin dosing system. I’m hoping to retain my private insurance coverage for the G4 as I don’t think Medicare will even begin to understand the tech I employ, much less cover it. I’m in serious supply accumulation at this point.

Great writing. It’s refreshing to read the good stuff! It reminds me of how much starting on a Dex 7+ CGM in September 2009 helped me to learn how my glucose metabolism works. Watching your CGM closely provides a valuable education, first and foremost.


#172

Yes, I don’t think Medicare would understand or approve of your looping… :grinning:


#173

My Dexcom is covered 100 percent between Medicare and my supplement. My endochronologist sent my paperwork in and I had it four months after the first application.


#174

Hi Jim,
I know your thread is a bit old, but I thought I’d comment. In my opinion, the worst company to deal with was the first one that received Medicare approval, and then they decided to bail out! That was Liberty Medical. I did everything they asked, numerous times, they lost and mishandled the paperwork, and then (despite me completing all the things they asked) they said that I hadn’t done it in time (nonsense!) and they weren’t filling any orders! This dragged on for months–I got promises of supervisors calling me back (which never happened), etc.
Dexcom stepped into this mess and eventually (not without their own hiccups) things are “almost” routine for those of us on Medicare. I also think there was lots of confusion and back and forth between Dexcom and Medicare on the exact requirements. So at least for me, I give Dexcom a pass for that tumultuous beginning (since Medicare itself didn’t seem to have its act together). In all my other dealings with Dexcom (since 2015) they have been stellar.
Just my two cents. Thanks!
Todd


#175

It shouldn’t matter if you use insulin or not, all diabetics should be allowed to have a CGM as it would motivate them to check blood sugar levels more often.


#176

I agree with this, @Kelvin. Learning how your glucose metabolism works is important to every person with diabetes. While this can be done with strategic finger-sticking, the CGM trace is the best way to learn how food, insulin, and a myriad of other factors interact.


#177

I agree. It wasn’t until I had my Dexcom that I really came to the realization that ‘we are what we eat’!


#178

My instructions were an “average” of 4xs/day.


#179

Admire your wife’s resolve on this…and how many C-Peptide tests does one have to submit over the course of years!!! That one gets me more than anything…Dear Medicare, My pancreas no longer delivers insulin, what MORE do you need than that? Thank her for letting me vent out on that… ;0)