Hi
My name is Darrol. I saw that there was a group here recently and discovered that people were using the sensors more than a week. Well, I would still like to know how some of you are doing that
However, a week ago I called Dexcom to order a month of sensors. They called me back the next day to say that my Insurance was no longer covering a CGM.
To make a long story shorter---after several phone calls I found that BCBS has not been covering any of my Dexcom orders and yet Dexcom was allowing me to order sensors every few months telling me that I just had to pay the co pay of 10%, which I gladly did. Apparently dexcom was getting a verbal ok from my insurance each time and so they shipped the sensors. And they continued to ship sensors even knowing they had not received a cent from my insurance--for a year. Dexcom said that they would appeal it to BCBS and hopefully since they had been given verbal oks they will pay the balance---if not, Dexcom is telling me that I would be responsible for any balance. I told them I have no intention of paying any balance after being told for a year several times my insurance would pay the 90%.
Any thoughts?
thanks
Darrol
Hmmm, I just have a very different perspective on this. In my book, Dexcom treated you wonderfully.
To me, sending you the sensors for an entire year with only your 10% co-pay, on a verbal promise from BCBS that they (Dexcom) would be reimbursed the balance was quite awesome customer service, in my book.
Of course, no one can reasonably expect this to continue without actual documented approval, so it stopped. I'm not surprised Dexcom is expecting you -- the customer -- to cover the outstanding balance for goods/services you recieved. That expectation doesn't make them "bad", or have "mistreated" you.
That said, like you, I wouldn't pay it. However, not because I resent Dexcom or harbor any ill-will toward them (as you clearly do from this post), rather simply because I had not agreed to. We had no contract. I accepted the goods, and paid my 10% in good faith based on representations made by Dexcom regarding their interaction with BCBS, and Dex chose to fulfill the order under those circumstances.
This is Dexcom's problem, not yours. However, in my opinion you owe Dexcom some gratitude and thanks for their caring and flexible customer service.
The real culprit here is BCBS. That's where your scorn should be directed.
Hmmmm
I'll think on that
thanks for your thoughts
No sweat, and I hope I didn't come off as scolding -- that wasn't what I intended. As stated, just see this differently.
Of course, Dexcom might (and I believe probably will) become worthy of some scorn as they harass and harang you to pay something you never agreed to pay, rather than go after BCBS -- or simply swallow the loss for their decision to rely on a verbal from BCBS. Again, not your problem -- you didn't make, nor have any say, in that decision.
They'll go after you 'cause its easier. You have no power. BCBS does. Dexcom can afford to make one customer unhappy more than they can afford to ■■■■ off BCBS.
I empathize with you, Darrol, and I would be angry with BCBS and with Dexcom. I don't share Dave's perspective that Dexcom treated you "wonderfully". Too many times, the patient is placed in the middle between the insurance company and the supplier. It's not right and it happens often enough that it makes you wonder if they are playing the "game" to their advantage.
As someone who can't afford to self pay, I think the whole "you're responsible for any balance" line that they always throw at the patient is ridiculous because I tell them I want to know my cost up front prior to delivery so I can make an informed decision. Dexcom always prides itself on communicating and advocating on the patient's behalf to get you set up with a Dexcom system, so I expect that same service with my supplies and any authorizations needed to get those supplies.
To tell you after you've received a year's worth of supplies that BCBS would not cover? That's crazy in my opinion. When my Dexcom transmitter died, I was placed in the middle between the supplier and BCBS and had to go back and forth between the two, pushing for answers until I got an approval. It's exhausting and I blame both. Why should the patient be responsible in any way for their inability to communicate with each other? And no company in this day and age accepts verbal approval of anything, so I don't buy that story either. Sorry for the rant, but this sort of thing makes me angry that anybody is treated this way.
I surely couldn't afford a bill for a year's worth of medical supplies that I didn't expect to have to pay for. If BCBS isn't going to pay, tell us up front and let us make a decision whether we can afford a Dexcom system or not with a known out of pocket cost up front. This ship now and tell you how much you owe later trickery is not appreciated.
No contract? When I got my G4, I had to sign the Patient Information and Assignment of Benefits form provided to me by Dexcom and it includes the following:
I do hereby authorize Dexcom to submit claims to my insurance company/companies on my behalf, and my insurance company/companies to make payments directly to Dexcom for my continuous glucose monitoring products. I also authorize Dexcom to submit referrals to Dexcom’s contracted distributors if necessary to obtain reimbursement. I understand I am responsible for any deductible, co-payment, and other amounts not covered by my insurance company/companies. Dexcom will make every reasonable effort to collect payment from my insurance company. In the event the insurance company refuses to pay Dexcom, I will assume full responsibility for the payment.
I understand the OP's frustration, but it might be a bit more complicated to resolve than simply saying he has not agreed to pay if his insurance doesn't.
Thank you so much----I was going to reply to Daves thoughts but I think I will just state my feelings after thinking about what Dave said.
And I agree with you completely--for a company to ship you products FOR A YEAR--that have not been payed for --and they never communicated to me that they had not received a penny from BCBS ---IS HORRIBLE CUSTOMER SERVICE!!!!!
They should have informed me on my first reorder of sensors---3 MONTHS LATER--that they have not received payment from BCBS.
If I would have known that BCBS might not be paying for these I would have never ordered the DEXCOM. I do not have 3 to 4ooo dollars to pay this now!
When I was first looking into a CGM I was told that my insurance said initially that they were not covered. DEXCOM, said "we made some phone calls and got it covered, you will just owe 10%.
This got me going--ha,ha. I think I am going to copy and paste it as a reply to Daves post after all.
Thank you so much----I was going to reply to Daves thoughts but I think I will just state my feelings after thinking about what Dave said.
And I agree with you completely--for a company to ship you products FOR A YEAR--that have not been payed for --and they never communicated to me that they had not received a penny from BCBS ---IS HORRIBLE CUSTOMER SERVICE!!!!!
They should have informed me on my first reorder of sensors---3 MONTHS LATER--that they have not received payment from BCBS.
If I would have known that BCBS might not be paying for these I would have never ordered the DEXCOM. I do not have 3 to 4ooo dollars to pay this now!
When I was first looking into a CGM I was told that my insurance said initially that they were not covered. DEXCOM, said "we made some phone calls and got it covered, you will just owe 10%.
This got me going--ha,ha. I think I am going to copy and paste it as a reply to Daves post after all.
Funomance: I see you're in Michigan. If your health insurer didn't send you an explanation of benefits during the year, showing that your insurer wasn't paying, it might be worth contacting the Michigan Insurance Commissioner:
They have a booklet explaining how you can attempt to resolve an issue with your health insurer with assistance from the Commissioner's Office:
http://www.michigan.gov/documents/lara/FIS_2257_Brochure_-_for_web_361289_7.pdf
You might check with local laws if there is a "Bait and Switch" protection that you have as a consumer.
This sounds like a particularly insidious bait and switch scheme. Instead of just raising the price after you start talking to them, they ship you product for a year and then try to change the terms retroactively.
They will try to hide this as an insurance confusion issue, but no it isn't. You as a consumer know dang little or nothing about the funny money that may or may not be exchanged between the vendor and your insurance company.
I think it is also possible or even likely, that you were not directly dealing with Dexcom itself. Check any paperwork you may have. Sounds like you have surprisingly little paperwork considering the billing confusion.With the sale taking place over the phone there may be other state-specific phone sale laws that can kick into play too.
Thanks
Thanks
I would also appeal the BCBS decision to drop coverage of the Dex. How, or did they inform you of the change? Make sure you understand the full appeals process. Some insurers "offer" multiple appeal steps (in part,in the hope that you will tire of the process).
Was it lost somewhere in the frequently too complex Summary of Benefits?
Did you receive an EOB from BCBS every time Dexcom filled an order?
Did you read them and understand what was being denied by BCBS?
Get everything in writing. If you make phone calls, make sure you write down names and dates. Follow up! It is a freaking unbelievable pain for you! But maybe if you become a squeaky wheel, someone will apply some grease.Leaving aside the question of payment for the sensors, the OP was also unaware that you can run sensors for longer than a week. It's easy....
When your sensor runs out after 7 days and shuts down, leave it in, go to the sensor start menu and just selelct start new sensor. The old sensor will go through the startup procedure and ask for the 2 calibration fingersticks after 2 hours. The sensors almost always run accurately when re-started. Eventually when the sensor actually "runs out" you will start to get frequent ??? readings and "drop outs" (where the reading becomes much lower than a fingerstick for perhaps 30 mins and then "recovers". At that time it's worth putting in a new sensor. It's worth perservering through the ??? readings at first because the sensor will often recover after 30-60 mins and then continue to work well for several days. I only pull mine out when I get a lot of ??? readings. My current batch of sensors are lasting around 14 days, but I have had batches that lasted longer and one sensor that ran for 25 days (= 2 restarts)
Good luck
Joel
I feel for you. A couple of years ago they sent me the seven plus without insurance authorization and I sent it back without opening it. I did get approval shortly after. When I told them I was going to send it back they tried to get me to keep it and said they would work something out if I didn't get it approved. I don't trust companies this much. I don't plan on ever doing business with them again.