Hello…I have been reading the forum for about a year, but have never written
I have been insulin dependent for 35 years. I am male-aged 83 on traditional Medicare
I have used 2-3 Medtronic pumps and had had my Tandem for 13 months Last payment to CCS for the hardware ( I hope).
I stgarted on Dexcom CGM about 6-8 months ago… first on the G5… and after 90 days switched to G6.
First question is about the Dexcom.
I received my supplies directly from Sexcom until the switched me to a supplier 2-3 months ago. From Dexcom, I received my supplies … and was not billed anything.
With CCS I apparently am being charged the 20% that Medicare does not pay. First shipment of 3 sensors I was charged $ 45+. Nobody said anything, and I wondered if Dexcom did not charge because of Medicare problems.
My second CCS shipment included a new transmitter… and I have not received a bill yet… so I don’t know the cost.
I thought perhaps the Dexcom billing was because it was processed under DME ?
Is this what happened when others were switched from Dexcom to a private supplier ?
Second question: For many years I got my insulin through Walgreens and it was billed through my regular insurance under my Rx fee schedule.( several hundred dollars)
A few years ago, the pharmacist switched me to Medicare under DME and I never paid a cent… just the normal pain from dealing with the Medicare paperwork.
This week I received a bill from Walgreen HQ for my Jan 2020 shipment of insulin and since I get shipments every 90 days… I expect more invoices.
The first invoice was for $ 70-80 so it was probably for the 20 % copay… since I get 6 vials of Humalog every 3 months.
I have looked online at my Medicare claims, and they always show the inflated charges people bill Medicare… and what Medicare allows… and Medicare sends the claims to my private insurance… but it never pays anything, since it is not a Supplemental policy, but my insurance from my retirement.
That insurance paid for my first pump… pre-Medicare…and supplies… but since Medicare started coverage at age 65… private insurnce pays nothing for pumps or pump supplies.
I guess I thought since I paid nothing for insulin since they started billing it through Medicare DME I was home free.
When I started the Tandem pump… the inservice rep/RN said I must have had a pharmacist that knew how the system worked to get the insulin free.
So… why I am writing is : I wonder if I am paying about the same as the other patients on traditional Medicare for Humalog and also for the Dexcom.
Sorry for the long dialogue.