I have no idea what to do… when they analyzed my insurance the dexcom rep initially told me something in the $300.00 range for the intital kit with my insurance and then like 80$ ish a month for sensors. Well everything went through a 3rd party called CareCentrix and on my statement it says the charges were 2475.00 for the start up kit and the box of 4 sensors so my out of pocket co-pay is now over double what was quoted and I am going to have to return the dexcom seven system
Is that what the cost really should be? I had no idea! Could there be a billing mistake?
A few things could be going on: There could be a billing mistake, or you could have not met your deductible for your insurance plan yet, or you Dexcom rep may have interpreted or received inaccurate information from your insurance co. regarding what they would cover. I would call your insurance company AND Dexcom and ask them again to clarify what this should actually cost you, and why you are being charged so much. My guess, though, is that the Dexcom rep quoted you what the price would be, but only after you met the deductible for your insurance plan.
I would call your insurance company (not CareCentrix) like Erin said. Laura in the Animas group had a problem with CareCentrix recently that said something totally different than her actual insurance said.
Most insurance companies have a fixed price of what they pay as opposed to what they are actually charged. Maybe Dexcom was expecting that $2475 to get marked down. American Diabetes Wholesale sells the Dexcom kit for about $1k and a box of 4 sensors for $350. Your insurance was billed about double what you could pay cash for. It is possible that CareCentrix was supposed to adjust the billed price and didn’t. It is also possible Dexcom was going to bill a specific amount to your insurance and didn’t. You will need to make phone calls to find out what happened.
After being quoted a similar pricing structure as yours (80%-20%) and initial acceptance from my insurance company (Cigna), I got an e-mail from Dexcom indicating that the claim was denied. I had to call Cigna and inform them that the Dexcom unit was not a replacement for the OmniPod, but instead an “in addtion to”. It seems they don’t know the differences or functions of these devices, which seems odd to me. Undoubtedly, you will have to spearhead the initiative to get this all figured out. Your price of $2475.00 may just be a lack of understanding by the parties involved. By the way, here is what was quoted to me originally by Dexcom:
Another possibility is that when companies like dexcom check with your insurance and get the benefits quote they are able to get information based on the contracted rates after the discount has been applied. What you see on the bill is what is billed which is far higher than the actual contracted rate. You actually have to wait until it goes through the insurance to see what your actual contracted rate and copays will actually be. So your dexcom quote may be accurate after all.
Or it may not be if the quote came from Dexcom but Carecentrix is actually the one handling things. I noticed that Edgepark charged more than Dexcom did but I had to go through Edgepark because of insurance. Now I can go through Dexcom directly and my copays are lower. (My copay is 15% but I have to use a preferred provider.)
It could also be a billing error. I know that initially my insurance paid for the sensors but denied the starter kit saying it wasn’t preauthorized. Well that was incorrect the insurance actually preauthorized all 3 at the same time and I had the letter to prove it. But when it came time to pay for it the computer only recognized the sensors as being preauthorized. Once they pulled up original paperwork and saw it was their error they paid for the starter kit and my copay was exactly as quoted. It took a phone call to get that straightened out.
Thanks everyone, Carecentrix can apparently bill whatever contracted amount they have with insurance so the 2475 was accurate Dexcom rep I spoke to was shocked but for whatever reason with my insurance (which is crappy in general) will only go through the 3rd party - in this case carecentrix. So for now the CGM is returned : ( It seems really stupid. I am in my twenties and already having a horrible time with complications - I had cataract surgery this summer in fact. I am tired of fighting health care for help and I am honestly doing my best. Our health care system frustrates me so much.
Thanks again everyone,
That’s frustrating. I noticed that Edgepark also had quite a markup in product price compared to what Dexcom would have charged the insurance also. And since my insurance is a straight 15% copay and it’s the distributor that’s preferred (vs product for dme) at the time I didn’t have a choice. My copay going through dexcom is about half what it was with Edgepark for a 90 day supply. That’s one good thing that changed in January with my insurance. Other stuff has been a pain in the neck however.
There is a big difference between the amount that gets billed to insurance companies and the Dexcom cash and carry price. I was quoted just over $300 for a box of sensors thru Dexcom(cash price) and my insurance gets billed thru a 3rd party carrier $600 for a box.
My price on unit was $ 995 - paying cash. Senosors on 6 month buying plan was $ 280 approx plus fedex brought it to $ 304 per month - 4 sensors.
I find I get 7 to 12 days pretty consistently and best to swap out at 12 days while sometimes I get 13 and 14 days use per. I gave up trying to run that far as I prefer to get sensor stopped in morning at a point still operating so I have rest of day watching new sensor come up and stabalize.
I also find it best not to install/start sensor till body start up tubulence is over and back satablized and that helps prevent getting the dread ??? squak of the receiver/system.
I do not depend or trust first day on new sensor first placed and find second day much more reliable and consistent.
