Dexcom/Medicare ordering “issues”

Diabetes Technology
1

This has happened to me about 3 times in the past, so I just want to see if it’s only me that it’s happening to. Here’s the short version: I check Dexcom’s website, because it’s time to reorder, and I haven’t heard from them. I get a response that I am not eligible to order, so I call. The representative tells me that my authorization has expired. They verify my doctor’s name, and then tell me that they have tried to contact her several times, but she has not responded. I start a process that lasts a week or more of verifying with Dexcom what they need and contacting my doctor to get it sent to Dexcom. This last time, I was told to send the certificate of medical necessity. Doctor’s office called and told me it was on the way. Still nothing from Dexcom. I called D again, and was told that the first rep. had told me the wrong thing. They needed chart notes, not CMN. Long story short, they overnighted me one sensor to replace the one I’m wearing, which expires tonight. It was on my porch this morning, but I give Fedex the props for that.

As I said, this has happened more than once, and it’s like the people I talk to are reading from a script that they have memorized. They always call on Friday. If I’m lucky, it’s in the morning, because their reps, in my experience, don’t understand why contacting a client in the eastern time zone at 5:00 on Friday doesn’t get an immediate response from the doctor.

Has anyone else had this experience with Dexcom? My experience with my doctor is that everyone in her office is very responsive. I’d like to figure out a way to keep this last experience from happening again.

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2

I do hear about this delay quite often and it always seems to happen to patients treated in a small doctor’s office. This scenario has happened to me several times over the past few years but it is always cleared up between my treatment center (Joslin - Boston) and Dexcom within 2-15 hours. Joslin is large enough to have Dexcom patient advocates full time on staff who know all the ins and outs at Dexcom and get these situations resolved very promptly.

3

I think it all depends on the customer service person you get, They can tell you the wrong thing, spin it, make excuse for it, not pay attention to it. But most of the time I get very good customer service.

4

Nope, not for me. When there is any issue, Dexcom contacts the Dexcom patient advocate at Joslin and illico presto, problem is solved. There is no way I am interested in finding out what happened behind the scenes, who said what, who may be at fault, what went wrong, I simply don’t care. The only thing that is important is that the issue is resolved promptly and I receive my monthly medicare supplies on time and that approach has worked flawlessly over my years on monthly medicare Dexcom CGM subscription package.

5

I am on Medicare and was on the G5 until Jan when I was switched to the G6. I never had a problem until the last 2 orders (Jan and Feb)
I have been given every excuse. It is a new year, I am transitioning to the G6, your doctor needs to submit some paper work (not true) etc.
In Jan I was without sensors for 10 days since my order took 3 weeks to be completed and delivered. I was told 3 times they would overnight my delivery but it never happened. Not sure what is going on. I would like to find a supplier that might be able to give me a 90 supply so I would not have to go through this every month.

6

Medicare does not allow 90 days of sensors to shipped. They will only authorize 30 days at a time.

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7

I was told I had to go through Byram by a Medicare consultant. Actually, she gave me a list of companies that are on the Medicare site that work with diabetes supplies. Out of about 10 companies near me, all had stopped working with Medicare except Byram. I contacted Byram, got my supplies, but on reorder I asked them why I was going through them when I could just continue to order directly. The lady with whom I spoke said there was no reason whatsoever, so I went back to ordering directly through Dexcom. Not that Dexcom is any better (their customer service is horrid), but at least it is one less company with which to become frustrated.

I hate the high price of insulin , is this a cool website or is it funded by big pharma ?

8

I’ve read reports from other Medicare beneficiaries that some companies, like US Med, actually ship a 90-day quantity of sensors but then bills Medicare monthly. I’ve not personally used US Med, but I’ve read this many times from different people over the last several months.

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9

They’re violating Medicare rules by doing that and putting their contract with Medicare in jeopardy.

10

Nick, do you use an insulin pump? The reason why I ask is that, if you use a pump, and your doctor files the certificate of medical necessity for it, Medicare pays for your insulin under Part B, as supplies for your pump, once the Part B deductible has been paid. I picked up a 90 day refill last week, for $0.00.

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11

Forgot to add, this is under original Medicare. Medicare Advantage plans don’t cover it.

12

I have better coverage under Medicare for insulin and my pump supplies than I did when we had any number of group plans. It’s hard to beat free (the cost of the Medicare plan and supplement is no worse than some of our other coverages across the years). I can rack up a 1/4 million dollar bill for a hospital stay and surgery and my cost was ZERO. As are all of my labs, doctors visits, MRI’s, CAT scans, you-name it. ALL INCLUDED for no copay, with Plan F from UHC.

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13

I am on Medicare. US Med ships my Dexcom supplies 3 months at a time.

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14

I am also on Original Medicare. I used US Med for a short time and they shipped me a 3 month supply also.

15

When I started with Dexcom in early January, via an inside sales rep, she never even gave me the option to order directly from Dexcom, just a bunch of Medicare suppliers. I moved away from my Libre supplier (Edwards Healthcare) because I had a similar problem at every 6-month point. They claimed they sent requests to my Endo’s office, who claimed they didn’t get it, etc. The worst was that this could go on for more than a week without anyone telling me there were problems. Invariably, when I got called to find out and got involved all the paperwork happened within 24 hours (my Endo’s office is very responsive to me always). They did, however, ship 90-day orders of Libres - supposedly to even out the 14-day cycles.

So I’m now with US HealthLink, which pissed me off a bit on this first 30-day sensor refill. They called on Monday (they had said they’d always call me to remind to reorder - which is great) and knew I was scheduled to replace my last sensor on Thursday. They shipped out my sensors 2nd-day on Tuesday but with late delivery they didn’t come until 6 hours after my sensor expired. If it weren’t for the fact that that I had been doing restarts, I would have been sensor-less.

I’m also waiting for them to short me one sensor in March, as I go in to the hospital for surgery on March 26th with a 5-7 day stay. This makes no sense as once I put a sensor on it’s not like I can take it off when I go in and re-use it when I get out, even if the hospital staff won’t use it.

I think I’ll wait until after I get my next transmitter and then switch to US Med to see if I can get the 90-day.

16

My latest ordering experience was no picnic. On Feb 11, I called DexCom to get my G6 upgrade kit. I had been told in January that I would get G6 in February, since my G5 transmitter was supposed to expire on Feb 6.

Up until three months ago, Dexcom would call me every month like clockwork. But the last three months, I’ve had to call rhem, and the people all have very heavy accents and a poor command of English, almost unintelligible.

On Feb. 12, my new G6 receiver arrived by 9 AM. On Feb. 20, I still didn’t have my G6 transmitter and sensors, despite two calls to them (which they did answer within about 20 minutes each time). My third call got the excuse that while my order was released by sales, it had been held up in the warehouse for (unintelligible) reasons.

Fortunately sensors and transmitter arrived on Feb. 21.

17

That’s good to know!! I suspect Thomas1 is correct that it is not totally above board. They are either outright violating the Medicare contract or they are, at least, accepting the risk that they may not get paid for some of the months. (If something happened, they would be out the money). Only caution I have for people using companies that are doing that is read the wording of anything they send you that requires your signature. Medicare requires something called an ABN “Advance Beneficiary Notice”. I know that there are circumstances such as if something is not going to be covered that people have to sign that form. If they don’t sign it, then I believe you cannot be billed for the item if Medicare denies. For example, Medicare won’t pay for a Hemoglobin A1c level if your diagnosis code is doesn’t match their list of codes that they think should be used. If your doctor ordered that test without using a diagnosis code that Medicare approves of, then you would have to sign an ABN stating, basically, that you understand Medicare most likely won’t pay for this test. If no ABN is signed, then you cannot be billed. So if you are getting 90 days worth of supplies keep an eye out to make sure that you aren’t ever signing an ABN. I believe the same would be true as with the lab and other services, if Medicare decided not to pay (for whatever reason) then the DME supplier could come after your for payment and it isn’t like you can just send them back (since you probably already used them).

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18

I keep seeing and hearing the same thing. You need to “complain” (politely) and let Medicare know that things are getting cut to close. The US is split up into four jurisdictions (at least for DME).
Jurisdiction A: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York - Entire State, Pennsylvania, Rhode Island, Vermont
Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
Jurisdiction C: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia
Jurisdiction D: Alaska, American Samoa, Arizona, California - Entire State, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri - Entire State, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming
Jurisdiction B & C’s contractor is CGS Administrators, LLC.
Jurisdiction A & D’s contractor is: Noridian Healthcare Solutions, LLC.

The DME Medical Directors are:
Jurisdiction A: Wilfred Mamuya, M.D., PhD
Noridian Healthcare Solutions, LLC
PO Box 6727
900 42nd Street South
Fargo, ND 58108-6727
Wilfred.mamuya@noridian.com

Jurisdiction B: Stacey V. Brennan, M.D., FAAFP
CGS Administrators, LLC
2 Vantage Way - Metro Center
Nashville, TN 37228
stacey.brennan@cgsadmin.com

Jurisdiction C: Robert D. Hoover, Jr., M.D., MPH, FACP
CGS Administrators, LLC
2 Vantage Way - Metro Center
Nashville, TN 37228
robert.hoover@cgsadmin.com

Jurisdiction D: Peter J. Gurk, M.D., CPE, CHCQM
Noridian Healthcare Solutions, LLC
PO Box 6727
900 42nd Street South
Fargo, ND 58108-6727
email peter.gurk@noridian.com

Anyone who has a story of cutting it close because can’t order sensor until “X” date and then their is an issue, I would write them and tell them. Let them know that because you cannot reorder until just shortly before you are due to put the next one on, it is cutting things too close. Any sort of “mishap” such as needing documentation from the provider, mail is slow, weather, whatever, and you are stuck with no way to monitor your blood sugars. Ask them to consider revising this so it doesn’t cut in so close. Tell them without the sensor you are flying blind.

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19

In my area you can. It can be an uphill battle but you can get some of the MedAdvantage plans to play ball.

20

This is especially pertinent now that Medicare will not cover test strips for patients using the G6 sensors.

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