Insurance nightmare/rant

I’m trying to get Medicare and my DME to get sensors to me before the 30 renewal period is over as I’m leaving on vacation. First vacation in 30 years, BTW. It would only need to be a couple days early. So far no deal. I do have a very accommodating customer rep at United Health Care who is going above and beyond the call of duty. I’m waiting to hear back from her now. I ordered them yesterday from Byram who said they could get a vacation waiver. When I called United Health care today to ask if that was happening, she called Byram and they told us they can’t do that. No one fron Byram called an let me know. If I hadn’t called UHC, I’d be sitting here waiting for the to show up. Rant over.

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Do you need G4/G5 sensors or G6?

I travel a lot internationally and have gone through that fight a couple of times with Dexcom and they will not budge, not even to ship 1 day early. Their excuse is always Medicare will not reimburse them That is why building up a supply of a few extra sensors by doing sensor restarts is the only work around unless you want to purchase a few which in the overall scheme of things is really not a lot of money or ask someone who has a few extra to lend you what you need.

These companies can be a huge headache to deal with. We retired and moved and my husband had worked for the state, but we had to switch which insurance plan we had because of the move. We were assured by everyone we talked to prior, many calls we asked prior to moving, you are covered for 60 days and just need to pick a new plan before 60 days after you get there. And we found out after we moved, it turns out that when you switch it doesn’t start until a full month passes after the month you’re in. Also not told to us on the many calls.

Not so easy, we move and I reinjured my back from a chair breaking, besides being type 1 and the waiting lists for endos. So see a doctor first so you can be referred and wait. Plus I needed my back checked and my BG’s were dropping like crazy because I wasn’t eating much.

Okay, emergency room paid, doctor no, endo she got me into right away, no, blood no. Dexcom, no. Okay the route it turns out I have to go is get turned down because the carrier says non emergency (what, never told anything about that) then submit it to Calpers who says we are covered, gives it back to the insurance company to approve it as necessary treatment (an appeal) and if it doesn’t work send it back to Calpers who will make sure it is covered. That last step we didn’t have to do as the appeal worked with the explanation of why I needed it. They didn’t get that from the doctor???

And now it looks like the Dexcom thing is messed up. The new endo submitted and got a preapproval under the old insurance and I got it right before the insurance switched. I just got sent a bill for 3 sensors $225 and 1 transmitter $120. I called my insurance because this didn’t make complete sense, almost sounds like no coverage and I know I have some. When I called they said they were billed $5,000 and they covered everything except for this. Uh what???

I have a feeling the supplier got turned down from last years insurance when I got the whole set up, When it was fully covered and preapproved so they then rebilled it to the new insurance? Because them being billed for $5,000 for that doesn’t make sense. Or who knows??? So I have a call twice to the supplier and no call back yet, because I need the turn down and then resubmitt it under the old insurance, which I will owe nothing for.

Sigh, insurance companies. Of course with the new year everything was turned down until we signed the bills and then called saying we had no other insurance.

I use G4/G5. Just got off the phone with DME. They offered to ship overnight and eat the $45 overnight fee. Now if FedEx does it’s job…


I’ll send a lot of good thoughts your way!

I think that is medically negligent.

So I spent almost two hours on the phone the other day with insurance customer service who was trying to get the DME to ship a couple days early so I would have sensors BEFORE I left on trip. They said absolutely noway could they do that. End of discussion. Cannot ship until the 30th. Well, a different person at DME left me a voicemail yesterday saying sensors would ship on the 28th. I’ve just ripped out my little remaining hair! Can’t wait to see what actually happens.

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@Zander, You can hope one doesn’t know what the other is doing! Because otherwise the one will tell the other not to do it! Or maybe not! lol, Sending happy positive thoughts your way!!!

Have you tried extending your sensors? This can help build up a backup supply, and reduce stress at reorder time.

When I was getting a 90 day supply, it was never a problem. This 30 day Medicare thing is absurd. I’ve tried extending sensors, but never had much luck. After 3-4 days, they go wonky.

Even if you extend them 3-4 days you will build up a extra one in a little over a month.
It just helps having a cushion so you don’t have to worry about shipments as much.

Dexcom G6-It’s just so weird they seem to go wonky on some people more than on others?? I extend mine constantly and have a nice supply built up now. I like them better when I extend them as they are accurate by then and I don’t have to mess with starting a new one. I’ve had 3 go past 20 days now and I think those have all been pulled off because of tests etc, not because they went. Don’t get me wrong, I’ve had ones go wonky, one went at 14 days. But with 3 going over 20 days (one was on day 27 when I pulled it off) I have over 6 extra sensors from that time alone.

I have to keep using Skin Tac to keep them on and they seem to get cruddy because of that. So I ordered the Grif Grips, cut down the first one to put over it at first, then I can apply the second one over that, to keep it looking nice. (I wear them on my arm) Just got them so I haven’t made it to the second patch yet. But it looks all nice again with the second one over it!

Maybe because I put them on my arm?

It’s not just Dexcom. I’m still waiting on a shipment of infusion sets and reservoirs for my pump that should have shipped about a month ago from CCS Medical. The online info about the order says that they’re still waiting on a prescription, which I verfied by phone, twice, that they already have. I spoke to a Medtronic sales rep, who very kindly sent me a free box of infusion sets, but was completely out of stock on reservoirs. My CDE had some reservoirs, about half a box. I was running low on those when I saw my endo yesterday, and fortunately she had some more. Every time I check CCS Medical’s website for information on the order, they’ve moved the shipment date back another week or so. When I talked to them on the phone, they said, “Contact your doctor for samples.” I’m not sure how many more times I can do that. I don’t know who to yell at next. Figuratively speaking, of course.

@MamaB1 I would call your supplier CCS Medical and ask for a supervisor to find out exactly what is going on. If it’s a supply issue, they can’t do anything and you could then call Medtronics and ask for a supervisor. If it still is a no script thing, I used to have a real problem with Walgreens and scripts. My doctor would electronic fax it and Walgreens would say they never got it, I’d have to do that 2 or 3 times sometimes. I never had that issue with CVS so I know it was Walgreens. These companies will just sit on something and not contact you with a problem. And sometimes it needs a supervisor to straighten it out.

The next step is, if everyone is out and you can’t get another emergency supply, call your doctor and ask what alternative is available immediately because you will be out and will need to figure out the best alternative. Hopefully from one of calls you will know a better time frame you will be dealing with. A few days, maybe shots, so not so bad, but weeks???

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Call tech support and tell them that your sensor is bad behaving. They will ship you a replacement for free.

This sucks! It’s part of the damned logistical anxiety that those of us with chronic conditions unjustly face.

I would escalate, escalate, escalate. Get names, get numbers, get emails.
Set a date & time that they will get back to you. When they don’t, call them. Demand overnight shipment at THEIR EXPENSE!

If this doesn’t work, or they don’t want to cooperate, call the insurance company and find out what other suppliers are available to use. In theory, CCS works for them, find out who you need to talk to at the insurance company. Escalate, escalate, escalate. Actually, you should document this instance and let the insurance company know that this vendor is not performing, period!

My wife uses CCS for years and never had one problem

But clearly there is one here …

We should all have zero problems, and I’m pleased to hear of your wife’s experience.

That’s the crazy thing with these places - if you look at reviews none of them do well - yet some have no problems and others do.

My general experience with the ones that I have dealt with is as long as you fit exactly within THEIR parameters, then all is fine, but when you don’t fit then it’s a recipe for failure.

(See - Square peg, round hole)

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