Help with doctor getting info to Medicare to okay CGM supplies

My endo retired a year ago. Initially I had my then PCP handle my diabetes, but he threw a fit when I had an A1c of 5.4 and when I wouldn’t go along with his “no more corrections” idea, I found another PCP. She’s a new doctor. I first saw her in September. The pharmacy that provides my CGM supplies told me just before Thanksgiving that they could provide no more sensors or transmitters until they got the okay from Medicare and that Medicare was waiting for a reply from my doctor. I ended up going without supplies for a full week before she got the needed information to them.

Last Thursday I accidentally tore off my last sensor. I called the pharmacy with a request for a rush shipment of the next ones and was told that they couldn’t send any because they were again waiting for Medicare to approve it and Medicare was again waiting to hear from my doctor. If they were waiting to hear last November, isn’t this a little early for them “waiting to hear” again?

How exactly does Medicare contact one’s doctor? Is it a form they mail or what? What information does the doctor need to provide?

By chance I had an appointment with my PCP on Friday and she had no clue what information Medicare was waiting for. Neither she nor her nurse could find anything in her mail that looked like a request from Medicare. Her supervising doctor came in after the appointment and he didn’t seem to be familiar with what Medicare required under the circumstances, either. So anything others who have dealt with such problems can help me with would be appreciated.

Looks like I’ll be back to fingerpokes for days again. At least I expect a replacement sensor from Dexcom will be here before the Medicare okay goes through, so I won’t have to wait quite as long.

1 Like

Report this to dexcom, they will send replacement.


Dexcom will send a replacement if you tear one off. They also have free overpatches they will supply. I suppose if you do it constantly they might give you an issue, but usually they just recommend things like the overpatches or SkinTac to help keep it on.

Medicare requires you to see your doctor before every 6 months is up to okay your CGM supplies. 3 months if you have a pump. I haven’t heard that they have to be in touch with your pharmacist every 3 months in regards to CGM supplies. It’s also possible your doctor wrote a 3 or 4 month prescription? They will want a current script or they have to get another prescription turned in. If that’s the case ask your doctor for a year’s script (37). She might have wrote it for 12 sensors, thinking that’s a years worth, but that’s only for a 4 month supply. A pcp isn’t always used to our kit. Medicare probably will not okay any more than the exact sensors required, so part of the problem could be if you want one before you are due more, they might not be okaying it, that’s where the replacement from Dexcom comes in.

I strongly suggest you restart some sensors to build a back up supply. Things happen and we come to rely on this stuff, so having a back up of everything makes our life easier.

  1. Let sensor expire or stop sensor.
  2. Remove transmitter while sensor is still stays on your arm, you can use
    a test strip or thin card, but a guitar pick works really good… - there
    is a hidden clip in middle of the sides of sensor - try to get it to raise up slightly
    on both sides and the transmitter will pop up.
  3. Wait at least 15 minutes
    longer is okay
  4. Snap Transmitter back into the sensor
  5. Start new sensor session using your original code

Using a strip might be easier for some, I still think removing the transmitter is just easier. Here is a video using a strip to block the signal without removing the transmitter.


Yes I called Dexcom immediately Thursday after it happened. That’s why I said in my last paragraph above that I was expecting a replacement which would likely be here before my Medicare supplied ones.

When I read your suggestion to restart some sensors to build a backup supply, my immediate thought was that such was a great idea. I knew that I would be incapable of doing it myself. With my severe arthritis in my fingers, most of the joints are totally frozen, and I’m not even capable of attaching my own sensors. But I thought my domestic partner, who attaches my sensors for me could probably do it. He tells me “no” however. With his tremors, he has his own problems. I’m sure a lot of younger people can do this easily, but with septuagenarians and octogenarians, it isn’t so easy.

I did a chat with Medicare on their website today asking about the questions I’d outlined here about what exactly my doctor needed to provide, but didn’t get very useful answers. About all the person was able to tell me that I’d need a new prescription. Anything above that the doctor would have to contact Medicare herself.

The doctor called me late afternoon and informed me of what she was doing to get this and my other prescriptions straightened out. I think we’ll get there. And when I talked to the pharmacist by phone he suggested that we aim for getting any required notes and prescriptions for CGM supplies for next time around in within five more months to make sure Medicare will have them as soon as they think they need them.

I’d try the test strip inserted under the end of the transmitter rather than full removal. That requires less dexterity.

Another option is to be “very sensitive” to errors in the Dexcom readings. If you get a few that are 20% off, you’re in a position to change them out early and claim a replacement sensor.

In addition, occasionally the sensor just comes off after six or seven days. Or knocks into a doorframe. Either of these will get a replacement.

At least this way, a small backup stash will accumulate to cover for those times when they’re late shipping.

1 Like

I thought I knew the answer to your question but then I went to find documentation and medicare says I am wrong.

Couple of things to know…

  • There is no expectation your DME supplier can send you an order early. You’ve got a prescription that says X per month or year and medicare requirements that limit you to the minimum quantity required.
  • Most of the paperwork is handled by the doc’s office, not the doc. I’ve changed doctors because their offices caused more issues than the condition I was seeing the doctor for.
  • In cases of finger pointing I recommend asking for proof of communication. I called company X to place and order and they say they are waiting or Doctor Y? When did X fax the doctor the request to do paperwork Z and does company X have the confirmation that the fax was received. Usually this will either move the conversation on to the actual problem or I can then call Doctor Y’s office and say hey I got an issue, please do paperwork Z or (my favorite) you find out the paperwork is done and you can go back to company X.

There have been plenty of lawsuits the DOJ has won against DME suppliers and pharmacies for failing to keep records that the article above says DME suppliers don’t have to keep. In my best Fiddler on the Roof Tevye imitation: “Contradictions”

Instead of extending your dexcom to build up a supply of spares I suggest asking your doc to prescribe a couple Freestyle Libre sensors and paying cash at the local pharmacy for it so Medicare doesn’t know. It is not as good as the dexcom but it is cheaper than cash for dexcom sensors and better than fingersticks in that it has a trend line.

1 Like

The weird thing is that I should have had a small accumulation of time toward the next Medicare sensors saved up by now. I’ve had to call Dexcom for replacements early two or three times in the last six months or so. And as I said in my opening post, Medicare was “waiting for my doctor’s reply” last Thanksgiving. So if my count is right, they are expecting it again now in five months, not six. Anyway, it didn’t work out.

I don’t think I can use the Dexcom errors as a very good excuse, though. While they are sometimes far off the first day, within 24 hours or 48 for sure, with calibrations I seem to get them within 2 points of my blood test with the meter I’d tested for accuracy repeatedly against my lab tests.

Thanks for the info, spdif. I started looking at the article, but will have to devote more time later (when I’m no longer working on my taxes, lol.)

I didn’t expect the DME supplier to send an order of sensors early. I called the pharmacy in a rush, though, because we had recently been informed that customer service at the pharmacy would no longer be calling us for the preferred date to have our packages shipped. It would be up to us to call them. And I had forgotten to call until four days before my last one would be used up. Unfortunately I accidentally tore it off so there went the last four days I thought I still had left. Until I called, I had no idea that my prescription was already up according to Medicare.

That can help down the road. Every time if accidentally removed my Dexcom I’ve contacted Dexcom directly, and they send a replacement. Maybe 4-5 times in the past few years. That has helped build a bit of a safety buffer for me— I’ve always got a few extras when my next 90- day shipment arrives.

1 Like

I just got off the phone with someone who does medicare billing for CGMs ADS. She was working the new customer phone queue and happened to mention what she did while apologizing for the three weeks that have gone by and ADS still isn’t ready to ship me a new meter and test strips. She says its up to the DME vendor to notify the doctor’s office the script/SWO/WOPD are expired and request a new one in time for your next order. In my experience this is all done by fax. The ADS person said she’ll follow up with a phone call after no response to multiple requests but lately has been getting stymied by clinics and medical groups call centers.

1 Like

If the DME supplier is the one responsible for contacting the doctor prior to anything needed, that leads me to conclude I’d better put a note on my calendar to check with him about that time to see if everything is going smoothly. I think I’ll also call the doctor’s office tomorrow to see if I can make an appointment for a diabetes consultation in about five months to be sure an appointment time will be available at an appropriate time before I need it.

I received the Dexcom replacement this afternoon. Although I had my BF attach it after dinner, the reader refused to work. I discovered that the reader was desperately in need of a recharge before I can even get the sensor started. So it is on recharge now. Hopefully all will be back to normal - and waiting for a series of calibrations - in a short while.

I have accumulated not just a ridiculous number of extra sensors, but also so many transmitters that they’re close to expiring by the time I use them. One failed part way through a ten day session, and I only learned its age when Dexcom refused to replace it.

I just got my quarterly supplies, and for a short time I will have three unopened transmitters. I’m on the 10th session with the current transmitter, and was surprised when it did not warn me I was starting its final sensor session, which suggests I might get one more out of it.

If anyone finds themselves in desperate need of a G6 sensor or transmitter, let me know and I can provide.

I’m in a similar situation (in Canada, where I imagine the insurance company issues may not be quite as acute, but still. . . ).

I have to carefully rotate my stock so that I’m using the oldest transmitters and sensors first. I think I’m up to three transmitters and at least six months of sensors in my current stockpile.

I’m I bit like a squirrel. I am always storing for a harsh winter.

But happy to help someone out if you’re in a jam.