I just received my first shipment of nine G7 sensors (a 90-day supply) today from US Med. I was told when I placed the order that they could not ship me the G7 receiver since my last Medicare reimbursed G6 receiver was sent in June 2019. I would not be eligible for a new receiver that Medicare would pay for until June 2024.
Since the G7 blood sugar values can be displayed on my smartphone, this is not essential for me. I was worried that Medicare would not pay for sensors without the required receiver. I wonder if Medicare has relaxed that requirement with most people using their phone instead of the receiver.
Anyone else get a 90-day Medicare shipment of the G7 sensors without its receiver?
I am curious how you end up liking it. My endo has recommended to not switch to it yet. That she has seen some issues with her patients that have started using it.
I am also thinking you might wait to use any of it until you make sure Medicare is actually covering it since you were told before it wasn’t covered. Make sure US Med got the approval from Medicare before they sent it. Or you should be able to see a statement online from Medicare or you will get one in the mail. Mistakes can be made from companies that send stuff to people since there is all kinds of different insurers.
I do know that Medicare denial of coverage does not leave the beneficiary on the hook to pay. My experience with US Med is that they have been careful to comply with all Medicare requirements before they ship. I’ll definitely monitor if Medicare pays US Med for this shipment.
I intend to use up some remaining G6 supplies before starting on the G7.
You’re right, @DrBB. I get pump supplies from Medtronic and their meticulous process sometimes borders on bureaucratic dysfunction. It makes sense that distributors emphasize getting paid as their number one priority. They couldn’t stay in business very long if they didn’t.
Thanks for asking @The_Burn for that important clarification, @Luis3! This distinction of Medicare’s apparent requirement of a paired dedicated receiver of glucose monitors, both CGM and BGM, is still not confirmed in this case.
Is the G7 sensor coverage an exception to the Medicare rule of the absolute requirement that a paired dedicated receiver (not a smartphone!) is required.
" In order to qualify for Medicare coverage of your Dexcom supplies, Medicare requires that you have a receiver that is compatible with your Dexcom CGM and that you use that receiver with your supplies, even if you also use a compatible smart device. Medicare does not cover Dexcom supplies that are only used with a smartphone or other mobile device. If you are interested in upgrading from a Dexcom G6 to Dexcom G7 and are not eligible for a new receiver, EHCS has options — please email our Diabetes Care team for details at DCA@myehcs.com."
I am on Medicare and my Dex G7 coverage is DME. They never asked me if I had a receiver, only if I needed one. Injury checked my EOBs and it was approved.
Your experience and report looks definitive to me. It aligns with US Med’s shipment of nine sensors to me while they clearly knew that I did not have a G7 dedicated receiver.
Somewhere buried deep in the bureaucracy are words that show this. I’d rather not take the time to discover those words; I’ll wait for my EOB to prove to me that the sensors are paid for by Medicare sans a dedicated receiver.
I’ve just been through a lengthy exchange with my DME supplier on this same question. I started Medicare last year and received the compulsory G6 receiver with my first order, so not eligible for another for 4 yrs. Upshot is, yes you’re required to have one for the G7, so if you’re not eligible you’re supposed to buy it yourself. Even though you don’t need it for anything. But there doesn’t really seem to be any mechanism in place to ensure you do that. My supplier (Wellstart) said something about having me certify I had one and leave it up to me to buy one (or not). Worst case is Medicare asks for a serial number, in which case I’d head over to CVS where I can get one for ~$90. But it doesn’t seem very likely. Because basically it’s a silly legalistic fiction and neither the DME supplier nor Medicare is all that interested in enforcing it except on paper.
In any case I found the whole question is moot for me, as I just started on a Tandem:X2 pump, which satisfies the receiver requirement for G6, and I’m told will do so for G7 once Tandem pushes out the upgrade.
Another option is to buy G7 receiver oop. With Goodrx coupon, only $70 cash pay, no insurance. I may do this and start G7 sensor purchases before Tandem pump is upgraded, and start accumulating G7 sensors and compare accuracy with G6.
How do you do this? I tried to put the G7 receiver in the search box for Good RX and it didn’t reveal anything useful. I am in a weird situation. I have been using a G6 without a receiver. Had a receiver for a Freestyle sensor in 2019 even though I don’t use Freestyle any more. I used the Dexcom G5 prior but was able to switch to the G6 without a new receiver. Edgepark is now telling me I can’t quality for a new receiver until 2024, therefore no G7 until then. Anyone know how I can fix this?
I’m on traditional Medicare, get my Dexcom supplies via USMed, and received my first shipment of G7 supplies (a three-month supply) about a week ago. I received my G6 with a receiver in November of 2019. USMed asked for the serial number on my G6 receiver then said I would get the G7 now, without a receiver, and in November of 2024 I could request a G7 receiver and one would be supplied and paid for under Medicare. But I could use the G7 now, paid for by Medicare, using a phone app. I suspect they know what they are talking about. I just checked my account on MyMedicare.gov but this latest claim hasn’t posted as yet. That is always about a month behind shipment or service being rendered. I suspect Medicare has quietly changed the requirement regarding receiver use.
But like I say, it doesn’t seem like suppliers are overly concerned with enforcing the receiver requirement for G7. Mine seemed prepared to ship on patient’s say-so that they have one. Not ordering the new sensors myself until Tandem compatibility established (which meets the receiver requirement anyway) but when I inquired that’s what they told me.
Your situation mirrors mine. I received at 3-month quantity of G7 sensors from US Med about 10 days ago and was told that I could ask for the G7 receiver in June, 2024, the five year anniversary of the last G6 receiver that Medicare paid for.
My Medicare claim has not yet been posted. US Med’s apparent response to the whole situation can only lead me to suspect that Medicare is not actively enforcing its absolute DME receiver requirement. US Med (and other Medicare DME suppliers) risk not getting paid if Medicare decided to enforce the letter of the law. This is not something that a rational business does without deliberate consideration.
Thanks. It worked now for me too. That is one hurdle I hope I can overcome, but the second is how do I convince Edgepark to supply me with sensors….when Medicare says I am not eligible for a receiver until 2024, so that they have declined the order for the sensors. Will it suffice to give then a serial number/receipt for the transmitter.
Many thanks again,
Susan
My supplier (Wellstart) indicated that Medicare might ask for a serial #, so yeah. At that point I didn’t know my (just purchased) Tandem counted as a receiver, so I figured if they did balk at shipping without it I’d bite the bullet and buy one OOP. At least with the discounted prices I’m seeing it’s not too punishingly expensive. For something you’re not going to use.
