so today, i found out my Insurance, won’t cover my dexcom supplies, i did call then, & did not get far, so i through i ask, if anyone had this happen,. if you did have it happen to you, what did you have to do to get them to cover then ?.
Hi @erice,
I’m so sorry to hear this, but don’t jump the gun just yet. This maybe a stop gap because something isn’t clearing due to a backlog of orders that haven’t cleared through your insurance. This happened to me a handful of times. The insurance company won’t clear further orders when there is a backlog to far back. Whoever you order your supplies through, you need to contact them and see if its because of this.
There could also be a cap in a dollar amount for a certain orders of a prescription level, which diabetic supplies are.
It could be that since its a “new” year and you maybe haven’t met your deductible that you won’t get certain coverage until you meet your deductible.
Its also again a “new” year and every year insurance companies change certain policies. I would look into the changes your insurance plan for 2016.
It could be any of these issues or something else. I have some good experience with bad medical insurance situations. I also used to work in Human Resources so I do have some experience with benefits and insurance lingo/problem solving.
I hope this helps with a place to start to ask questions.
Busybee
I lost my Dexcom coverage too. After 2&1/2 years of coverage, they decided they didn’t want to cover me anymore. My doctor has appealed to the insurance co. (UHC) but haven’t heard anything yet.
I got a letter from Aetna today, saying that Aetna needed a prior authorisation to cover my One Touch Ultra test strips. I have been using 8 strips per day for more than ten years. I crash occasionally and I’m labile and my previous doctor was always willing to make the call to Aetna.
So I ask my doctor to call and do a prior authorisation for my strips. Nurse called back and said I could get only 2 per day and no authorisation was needed. I wonder if she even talked to the doctor.
I am labile. I use Januvia, long acting insulin and short acting insulin and the doctor, or at least his lazy nurse, just won’t make the call to Aetna. I am going tomorrow to yell at the doctor. Now I am really miffed.
Deal with Dexcom thenselves, don’t even try to talk to your insurance yourself… It is an excercise in frustration to do so. Dexcom has people who liaison between patients, insurance companies and doctors offices to get all the necessary paperwork in order to ensure coverage, this is what they do for a living-- they’re good at it. Dexcom also has the financial motivation to ensure that you end up using their product… Your insurance has the financial motivation to lead you on a run around until you give up.
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so, i just got off the phone with Dexcom,they say that, they will talk to my insurance about this, i did ask about a backlog of orders, & they will ask about that, hope it get fix soon,.
Dexcom is out of network for my insurance but there is an in network distributor partner I can go through (Byram Healthcare), hopefully it is a similar case for you? Dexcom will figure it out for you!
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This is a good start.
I go through an in-network distributor too, not directly through medtronic for my supplies. I go through Edgepark Medical Supplies. I don’t know why they are approved and medtronic isn’t, but its the game I have to play to get approved and covered.
Busybee
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I put this first message inappropriately here in the middle of a conversation. Apologies. But I want to make here an addendum to my message.
The problem getting strips was a nurse issue, not an insurance company issue. I met the nurse again this morning and she acts like a zombie robot with a strange fixed gaze. I finally got in to see the doctor and he wrote me a script for six strips per day.
As a T2 using Humalog on a sliding scale, I don’t understand why they are so freaky about the number of strips. Eight strips per day would be “obsessive” he said. He made a gesture.
Note that this doctor does not have diabetes and admitted that 90 % of his D patients do nothing to treat their D. I made certain that he understood that I am not in that number.
So dexcom !. Got back to me, so far they say my insurance, won’t cover to it being out of network !. Hope they fix everything & do it soon.
My husband is 74, type 1, with a further diagnosis of hypoglycemia unawareness and lability. Blue Shield’s Medicare HMO covered his Dexcom CGM since 2010. United Healthcare now denies it on the sole basis of Medicare noncoverage, in spite of pre-enrollment assurances to us that they could make exceptions for medical necessity. (CALPERS dropped the Blue Shield HMO plan) So, Medicare specifically excludes CGM’s and supplies. There is an annual bill in congress to include these. Also, Medicare has appeals steps, and recently some of the administrative law judges have been ordering UHC among others to cover the CGMs. If you have a Medicare plan, keep detailed records of every phone call, every communication, and do an appeal. Most cities have HICAP offices with Medicare counselors and some are associated with legal aide for seniors. We are struggling and I hope this information helps.
Information helps me. I am 67 and UHC just dropped my CGM coverage. I am in my first appeal now and just learning my way. I wish congress would get off their butts and do something.
Same here ! I found out my like to do this a lot,. So far dexcom, say they are working on it still. & as for congress ! Maybe some day, they will. I hope they, something.
Google the case Whitcomb vs. Burley…this has become the basis for some of the Administrative Law Judges ruling that a cgm must be covered. I am going to legal assistance soon and will get back to this forum if there is any good information. Do check out your HICAP office. They really mean to help.
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