Hi, I’ve noticed so many people on here have to order through third-party medical suppliers for pump and CGM supplies. Lots of them have problems. I’ve been pumping with Medtronic for 14 years and using the Dexcom CGM for about 5 years. I’ve never had to use a third party company and I’ve have several medical insurance policies in that time. My supplies have always come directly from Medtronic and Dexcom. How can it be cheaper to involve a third party? How common is it to require a third party when the manufacturers are perfectly willing to ship direct?
When my dexcom was covered by insurance, I had to go through a medical supply company. I used to get my pump supplies direct but my pump is not the preferred pump by my insurance company so now I have to go through a medical supply company for them too. Seems it all depends on insurance.
My insurance has always covered pump and CGMS from DME suppliers only, never directly from Medtronics or Dexcom. I think it reduces the number of suppliers they have to deal with.
There are many non-D related medical supplies, so most insurance would already have arrangements with DME suppliers. So including pumps/dexcom is easier than arranging with companies that would only supply a few products.
My DME supplier may be able to get stock from Dexcom or MM in bulk, and get lower prices.
MM/Dexcom may prefer that because they just ship the product, and don’t have to bother with overhead associated with insurance approvals, doctor correspondence, etc.
On my previous insurance, I had a lot of options as to where to buy supplies, so was able to get CGM and pump supplies directly from the manufacturers. FOr the last several years, however, my insurance has only allowed me to buy supplies from a third-party supplier that is on their accepted list. For my insulin, it’s even worse – I must buy it ONLY from the insurance-company’s associated mail-order pharmacy – otherwise, I have to pay out-of-pocket. (They make exceptions for an “emergency 1-month supply” when necessary.)
I use Edgepark and they are awesome.
Ive used Edgepark for the last 7 or 8 years and thankfully Ive not had an issue with them. Rumor is Medtronic will finally a have direct sell agreement here in AZ so I can just order directly from them.
DME or direct is strictly the choice of the insurer in the particular state in which the policyholder resides. It depends on how much of a discount the DME supplier in that state is willing to give the insurance company. It gets more complex of a negotiation when the DME bids on more than one state.
Bottom line is it’s all about money.
It never made sense to me that involving a “middleman” didn’t add to the cost. I am on Medicare with a supplemental policy that, unlike Medicare (I know it’s changing), will cover CGM stuff once Medicare has been billed and denied.
Apparently Dexcom does not like to deal with that process and instead makes me work through a third-party vendor. I’ve been using Solara for the last several orders and have no complaints. I receive my Dexcom supplies a few days after ordering. It’s fast.
I’m not happy that edgepark requires I buy a receiver when I am using my Iphone. They said I had to buy it the first time ordering my Dexcom CGM. It shows a line item cost of $1203, but I have heard that the cash price is $400.
I bought a G5 receiver direct from Dexcom last year and the “discount price” (because I also bought a huge stockpile of sensors) was $599, from a “list price” of $756.
I have some heartburn with Edgepark…my insurance requires that I go though them to order CGM (which has been denied by insurance) and they gave me zero help with my multiple appeals.
So real quick, do you have a G4 receiver with Share? I was not required to buy a G5 receiver when I upgraded, but it may be because I told them I had a G4 receiver with Share and didn’t need the G5 receiver. I don’t think this is singular to Edgepark. My guess is this is a Dexcom/regulatory/legal thing that in the event that the iPhone stops working (may be as trivial as the battery running out) that you technically have a backup receiver.
So if you have (or even don’t have) a G4 with Share receiver, you should tell Edgepark that and see what they say.
Also, I assume when you call Edgepark you ask to speak directly to their diabetes department? I do this every time and they are super knowledgeable and helpful.
As @mikep said, when the G5 was approved by the FDA, a receiver purchase was required. Fortunately we are finding that it seems to be a onetime purchase rather than an annual purchase. A G4 Share receiver can be updated so that seems to work.
I used Edgepark for many years and had great service from them. However their "retail " prices are crazy and you have to be sure to get your insurance negotiated price. For me it never really mattered because I had a deductible that I always satisfied and then everything was covered 100%. But I never did understand their bookkeeping.
They basically said I had to have it on the first order. I obviously survived for the first 2 years as a type 1 diabetic (diagnosed at 55) and will survive without the CGM should I stop it because I can’t afford it. My beef is that DexCom’s cash price is $400 and Edgepark’s price is $1203. I have a $2500 deductible so I would rather have paid for it out of pocket.
If my phone breaks I will get a new one in a day or two, as well as a Dexcom receiver. I will not die.
So are you using a G4 with Share?
G5. I would like to sell it but I was told by the Dexcom rep that it is programmed to me somehow. Maybe to the transmitters I have?
Maggie - I sent you a PM. I’m so confused.
I get my Dexcom items through Dexcom. However all my pump supplies come through a company that is associated with the U of MI. I hate that place. I’m on hold much longer than I am whenever I have had a problem with either an infusion set from Animas or my Tandem T:Slim G4. The next time I need a script, I’m going to have them send it directly to Animas.
I use Edgepark as well.
My Dexcom supplies unfortunately have to come from US Medical Supply in Florida. They are awful. I received the Dexcom G6 system from them in October which shipped with 90 days worth of sensors and the transmitter. I didn’t order a receiver as I use the app on my phone.
I ordered my next 90 days of supplies last week, they arrived today. What’s the problem? They shipped a G5 transmitter and G4/G5 sensors.
Eternahold and the runaround. Just how I wanted to start my week.