I feel like I’m bombing this thread but I placed a call to Dexcom just now on an unrelated issue and asked about the transmitters being limited to just receiver reception for Medicare users. The person I spoke with on the order line had not heard of this happening. For what it’s worth.
If they did make a transmitter that couldn’t connect to anything but the receiver, this would seriously hurt the Tandem X2 and Animus pumps with the G5 integration. I don’t see Dexcom going along with this.
The wording on the CMS was specific enough so as to NOT include pumps within what the CMS would consider “prohibited” devices.
But I agree that I just don’t see Dexcom doing this. Plus such a change would require re-approval so it would be kicked way down the road.
The transmitter is Bluetooth, I don’t think they can design a Bluetooth device to connect to only certain things. My limited understanding of Bluetooth is it connects to anything Bluetooth enabled. Maybe CMS is going to make Dexcom play the role of big brother and report their patients for using a smartphone. Dexcom can track anyone’s BG levels if they have the clarity app enabled on their phone.
I just got a call from Dexcom asking for additional information so they could process my Dexcom starter pack. Yes, even though I am on a G5, per Medicare they will be sending the whole package (transmitters, receiver, sensors, Contour Next One blood glucose meter and strips). The way this will work is Medicare will cover the first 80% and I’ll need to submit to my supplemental BCBS for the remainder. That last is a hassle but, according to BCBS, it should be covered. Nobody can promise of course.
We spoke some about the whole smart device thing. She said she hasn’t heard a thing about Dexcom throttling the technology but instead they are warning everyone that Medicare will be monitoring or at least has access to the user’s Dexcom data. Yep. And if you use an app it will clearly show and your CGM benefits will be discontinued. I asked her when I should stop using my iPhone / Watch and she said when I get the Medicare supplies. I think I’m going to not wait and remove the app sooner than that.
I asked when I should expect the supplies to arrive and the estimate was 1-2 weeks. I had to send her a PDF of my insurance information and a signed copy of an Assignment of Benefits Authorization. They already have my doctor’s order on file.
I hope this blow-by-blow isn’t tedious but I expect there are a number of us in the same boat - wondering how this will go. The part that most pleased me about this step was how Dexcom called me. Wow. Such a nice change of pace.
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FYI…in my case the Kaiser endo nurse called Dexcom and had Dexcom send me the “kit” directly. For ongoing refills I call Kaiser DME. I have the dexcom app on my Samsung S5 and can see all the information on my phone that I can see on the receiver. I do not have to have the receiver with me to get the info. So specifically I can see my sugar level and the graph I see on the receiver. The same info shows up on my wife’s phone as well so she can follow me with dexcom “Follow” app.
lol - I am pretty sure people will be quite pleased with your detailed reporting !!!
And Great News on your Dexcom order getting processed !!!
This whole thing strikes me as just so… odd. I can understand that Medicare’s definition of “durable” requires the receiver to be included. But that being done, their interest is served isn’t it? What, statutorily, compels them to police what the patient does thereafter? And at such an intrusive and granular level? For my part I LIKE having the receiver as well as the app. Bluetooth, particularly in dense urban areas, is not altogether reliable and I often find that when one device is experiencing a drop-out the other is still connected. What earthly difference does it make to Medicare if I want to use both? It just seems weird.
I’m wondering about the technical details of this. I upload my Dex receiver to Dexcom Clarity. Is that the data that will reveal that I’m also using a smartphone program to monitor my BGs? Perhaps my use of Dexcom’s Share2 app documents my smartphone app use. I’m just thinking out loud here. I’m sure this point will be thoroughly explored by people much more technically capable than I am.
This is an unfortunate turn of events from my point of view. I’ve been living with a CGM system, the G4 with Share, for several years now. I can see my glucose status on my Dex receiver, my smartphone, and my apple Watch. This redundancy has proven its overall merit many times. I do realize that the Medicare coverage is limited to the G5 system.
I believe that @mremmers is accurately reporting what they were told by the Dexcom rep. And I have had good conversations many times with the Dexcom reps (sales and technical) and never had a reason to doubt them.
However this is stretching it. I would require more substantial proof that the Federal Government is going to be allowed access to people’s individual minute by minute (well ok five minute by five minute) blood sugar readings. It simply does not sound plausible. Doesn’t mean it is not true but to me it sounds very unlikely.
@Terry4, when I look at my data on the web, using a Mac, this is what I see at the bottom of the Overview. It lists where the data is coming from and, when exploded, give the date of the last upload. So, easily trackable.
@DrBB, boy do I agree. This seems like an implementation being forced to fit rules rather than rules following best practice. I’m hoping this restriction is eased once the dust settles.
I know we’re just speculating at this point. So, if you no longer upload your G5 Mobile to Clarity, then it would not be visible to Medicare. In fact, if you never uploaded any data to Clarity, Medicare would be none the wiser. There are alternate BG retrospective upload/analysis sites to use, like Diasend. Am I thinking clearly about this?
Good point. I don’t doubt what people are reporting, but are there any other instances where Medicare just blithely assumes the right to examine your personal medical data? They aren’t a medical agency of any kind, they are an administrative one. I share my Clarity data with my Endocrinologist, but that was by choice, via her sending me an “invite to share” from her professional account and my agreeing after logging in to my account. There’s no way I’m going to do that with a whole bureaucratic organization that isn’t in the business of individual patient care. So the only way they would have access to it is by compelling Dexcom to police it for them. Which seems at least as absurd as the idea of forbidding people to use the app even if they have the receiver. It just seems like an ethical and legal minefield.
I think that is probably the reality.
I wonder if the HIPPA rules apply to Medicare’s CMS.
I think so. There’s no requirement. If I plug my receiver into my laptop, Clarity launches, but I don’t necessarily find it that useful and if I had to de-install it I wouldn’t be nearly as put out as I would be by not being able to use the app. And there are plenty of USB->AC chargers around. I charge my receiver that way all the time.
I do know that Medicare beneficiaries who use a CPAP machine must prove that they use the machine x% of time. This is done by someone reading the chip in the CPAP that keeps track of that. If you haven’t used your machine enough, Medicare will no longer provide supplies.
Huh. Interesting parallel that, have to give it some thought. It does still seem different from giving them access to your intimate 24/7/365 physiological data trace, though. I can see where “Did the patient even use the darn thing we’re paying for” is a legitimate question, where “Gee look how many post-prandial spikes the guy had, is that a 300? nasty!” is um, not. But “we’re not paying for the device if you’re not even using it” does at least help me understand the underlying logic.
I also know that CPAP machines record the minute by minute details of when the sleeping person stopped breathing and for how long. This data would be equivalent to our BG data but I suspect Medicare leaves that info to the clinicians.
I thought you reported receiving a Dexcom G5 back on May 12 on another thread?
@mremmers "May 12
@Laddie, I have not received a statement from BCBS as of yet. Those tend to be quarterly so maybe I’ll see something in July? I’m a skeptic at heart and asked, twice, if there would be any co-pay, and I was told “no” that the CGM was pre-authorized and covered by BCBS. I then asked if I needed to sign anything like an ABN, which is pretty standard when Medicare is involved, and she said no. I’ve had zero billing issues with this medical supplier in the past. So going forward was a risk I was willing to take. My G5 arrived yesterday. "
Interesting that someone can get two G5 devices when others can’t even get one after waiting four months?
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