G4 transmitter - Need advice on dealing with insurrance

Diabetes Technology Glucose Monitoring
1

Hi,

I'm not very familiar with dealing with insurance companies. I tried to order a transmitter once my 6 months warranty was over and I got that answer from Edgepark: "Unfortunately Horizon has recently implemented a quantity limit of 1 Dexcom transmitter per year. They do not care if your current unit is out of warranty or malfunctioning. They only pay for one."

What in your opinion/experiences should be my next step? Is there any hope that calling and complaining can change their mind? I feared that they will slowly change their policies until I have to pay everything from my pocket...

thanks

2

Insurance companies can always make exceptions. Find where Dexcom says it's under 6 months warranty. Explain in detail why your current one is no longer functioning. Use terms like like "medically necessary" and "to avoid hospitalization."

Have you actually needed a new one every 6 months? My g4 was still kicking well at ~8 months when the transmitter went missing. I was hoping they'd last a little longer than 6 months, since my 7+ transmitters seemed to get 12-18 usually.

3

What problem are you having? Is it not working or inaccurate? What's the story? Yes, just wanting a new one is not going to get you anywhere.

4

There is no issue so far. My 1st transmitter lasted 12 months. The 2nd was ordered right after 6 months (I was new to this and afraid to be out of transmitter). My boyfriend didn't see the big red label and removed the transmitter out of the box so it's been ticking since May. I had money left in my FSA in November and tried to order the 3rd and got that message from Edgepark. I was just seeking advice on the possibility of changing their mind if I was complaining. Of course, I will wait until this one dies...

5

The letter would best be written by your diabetes physician, not yourself. There are lots of catch phrases that can be inserted to make it stronger.

6

My g4 transmitters have been dying at 6 months, and one actually died at 5 months. It takes a while to get a prescription filled so I can understand not wanting to be without a transmitter since these things can die pretty quick. If you’re out of warranty, you’re out if warranty. The policy is baffling. Dexcom sets those limits, not the insurance company.

7

I agree. The strongest argument to an insurance company is always “because my doctor said so.”

8

Since your insurance company already denied it I don’t know if you would want to wait until this one dies. Doing an appeal with some insurances can take months. I would think about starting it now just incase it takes months?

9

Thanks for the advice guys. I'll start right away by confirming with my insurance and talk to my endocrinologist about it in my next meeting.