I received a G5, fully paid by my supplemental BCBS, on May 11th. I don’t know why they were so generous and didn’t ask. It was with some trepidation I reordered sensors a month later - I was sure a bell was going to go off and the gig was up. But, no, again BCBS paid 100%. But I did squirrel up the courage to ask what happens now that Medicare covers the G5 and as expected I was told Medicare would need to approve and pay 80% before BCBS would chip-in. So, yes, I have a G5 and I need to work with Medicare from here on out.
Are you also aware that BCBS being a secondary or as you call it a supplemental insurance, more than likely billed Medicare as an Advantage Plan? Are you aware that Medicare Advantage Plans get their reimbursement funds through the Government? So in essence you are double dipping the Government. I’d say that’s a bit unfair if you ask me, especially since many other seniors have been waiting for months and haven’t even been ccontacted by Dexcom yet!
Really, @Jimbo31, I’ve got this. My supplemental isn’t an Advantage plan and Medicare wasn’t billed for the G5 I received last May. That was do to the generosity of my BCBS plan per the quarterly summary of BCBS services. Please don’t be angry here - I’m not trying to work the system or cheat anyone out of anything. Truth.
I’m posting a photo of the Assignment of Benefits form Dexcom asked me to sign. Tucked in there, quite clearly, is, “I consent to the release of all information, including medical records to or from my physician or representative of my physician and to or from the insurance company or DexCom contracted distributors, for the purposes of healthcare management and/or for processing medical claims.” It’s pretty boilerplate for insurance companies to have a release allowing them to monitor how the services they are paying for are being used and whether they are helping as intended.
1 Like
Not sure if this is off topic or not but this bundle presents another problem for some of us. I use the accu-check combo pump. I control my pump with my meter. If they won’t cover my meter and strips, I wonder how that will be handled. If I ever even get approved for coverage.
1 Like
This does show that you’re using the app, but of course what it also shows is that you’re using the receiver. Which is all that should matter. If they can establish that, it seems like an entirely artificial and gratuitously intrusive requirement to forbid you to use the app as well. They’re paying for the receiver, you’re using it, end of story.
2 Likes
How much longer is your Combo warranty? I ask because mine has expired and my pump cover is dying (the rubber has split on the “UP” button), so my days of controlling my pump with the meter are numbered.
I did like the remote control of the Animas Ping via the One Touch meter. That was certainly convenient. After six years with the Ping we finally had to retire it. Nothing lasts forever.
I am hoping that the Tandem X2 would allow remote control via Bluetooth with a Tandem software upgrade but have not seen this mentioned as an enhancement in the pipeline. It seems feasible and would be nice. Many situations where a remote for the pump is just nice !!!
I still have about three more years left. Will have to wait and see what is available after that since they are out of the pump business.
Support First Responders
I hated the Ping remote because it was so slow to communicate with the pump and the scrolling was erratic. That being said, the Ping was not my first pump and I was used to the instantaneous communication between the Medtronic Link meter and the pump. (The Medtronic device was not a remote.) People who have the Ping as their first pump think the remote is fabulous because they don’t have better devices to compare it to. Also I am an adult with diabetes. If I were a parent, I think that I would have loved the Ping remote.
Have been struggling for over 5 months to keep abreast of the Dexcom G5 availability thru Medicare. Guess you or I would call obtaining it not an urgent medical matter as I have been on G4, Seven Plus, and the worthless Medtronic Guardian for past 10 years. Although the CGM’s were paid initially with private insurance until commencing Medicare 5 years ago, I have been financially responsible to maintain CGM usage since on Medicare. As a side note to stress the farce of the Medicare coverage development, I actually obtained the G5 from Liberty on 3/27. Liberty of course withdrew from the Medicare involvement following its participation for 1 month stating “you got to be kidding, not worth the trouble”. Of course Liberty demanded payment & I sent the unopened box back to them.
Got in the habit of checking every 2 weeks regarding again obtaining the G5 via Dexcom and finally decided last week out of frustration to visit my endro doctor and speak with the only person I have found helpful on any medical matter in last several years. Briefly advised Mary(fake name) about overall situation and she said the Dexcom sales rep was coming the next day and she would have the rep call me. Rep called stated Mary had shown her my records and she would notify Dexcom to put me at the top of heap.
2 days later the G5 starter bundle arrived. Now have to transition to use the Contour BG meter instead of the One Touch which is integrated with my Ping pump but presumably if it is required by Medicare so what choice do I have… Starter bundle includes one receiver, one transmitter, 4 sensors, Contour BG meter, and one box of strips… Supposedly Dexcom then places a user on steady ship program…
Started pump usage 20 years ago with Medtronic. Was forced to stay on it for 4 years… Reliability was pathetic… Hated their proprietary issue. Switched to Animas and been satisfied for over 10 years. Still boils down to personal preference unless Medicare “prefers” something else. Then your personal preferences get tossed out the window.
Good to read that you’ve received a Dex kit that will be paid for by Medicare. Please update as you proceed through the payment process. Many here are watching to verify that this Dexcom/Medicare process will actually work.
Good luck with your new diabetes tech. You’re experienced with this going back to the Seven Plus. If you have any questions, feel free to post!
Nobody really know yet how BG strips will be covered under Medicare once someone receives Dexcom G5 coverage. Most of us assume that no more strips will be covered other than the two per day shipped in the Dexcom bundle. But will our doctors be able to increase the number of strips per day as they are able to do now?
I currently have a good stockpile of Freestyle strips and don’t have to worry about this for a while. As someone who has very good success with the G5 and doses off it frequently, there is no way that I could safely only use two strips a day. The first 24 hours of a sensor are not trustworthy and there are times that I know I can’t completely trust my CGM. Some days I only do 3 meter tests but my average is closer to 6. It used to be 10-12 before Dexcom.
I am pleased that the Contour Next meter system is considered very accurate. I was worried that we would get a crap meter and strips from Medicare.
Once I get to the point that I need to self-fund more strips, I’ll probably just buy Relion strips from Walmart. They were one of six meter systems that passed the DTS surveillance studies.
2 Likes
I’d like to see DTS-style surveillance done on an annual basis because quality can slip over time. I think there needs to be a cop on the beat or it tempts the bottom-liners to cut corners.
Of the 3 people I was in touch commencing Monday, the last or Dexcom administration person who was obviously just trained to determine eligibility based on recent Medicare guidelines stated to me that the starter bundle contained enough strips to test 4 times per day. Requested clarification as I thought a G5 user would only be allowed to test twice a day. All this person stated in response was “I think that is what is being allowed”. So really don’t know if there has been a change by Medicare. Dexcom I presume is really the advocate on this process & I hope Medicare is willing to acknowledge their expertise… Can only cross your fingers. I would only hope this issue concerning test strip quantity doesn’t take another 5 months. Restricting use to merely 2 times daily is not sound & essentially creates a situation for failure with the G5 simply because its reliability would plummet. Any experienced CGM user knows this to be self evident. As an example I found calibrating my G4 4 times a day clearly results in readings which are very close to my BG testing.
I think that you have a child with T1 and you might be moving from the pediatric version of G4 which did not have the AP update. For adults the algorithm has been the same for several years, whether G4 or G5, and there should be no difference in accuracy.
UNCLE! A few days ago I got email from my Dexcom rep and they’ve had to put another hold on supplying Medicare G5’s because of additional, new requirements for Medicare approval. She would need to schedule a phone “interview” first. I’d be asked about what technology I was using. So, on July 31st, I removed the Dexcom app from my iPhone. Fast forward three days and I’ve so missed seeing my number on my watch. I know, I sound so spoiled, but it is what it is. Too, I asked about the new Scout touchscreen receiver that is due to be released very soon. I was thinking that maybe not having the app would be a little easier if the same software/look was available on the receiver. Well, it seems that isn’t available to Medicare covered recipients - even if you want to pay cash for the upgrade. No perks. No upgrades. You’re locked in to current technology for three years.
So, I put a halt and cancellation on my application for Medicare benefits and have gone on a self-funded auto delivery plan. It will cost me about $9 a day. Not chump change but doable. Moving on.
There are Federal regulations which significantly restrict what companies with Medicare contracts are allowed to charge patients who are on Medicare. Violations can be serious for the company involved.
From Dexcom’s latest earnings conference call (2Q 2017):
“In addition, as we stated on our last earnings call, because of the January CMS ruling, we were, again, prohibited by law in Q2 from billing our existing cash pay Medicare eligible patients.”
So if you wanted to purchase Dexcom supplies/equipment (ie - the new Dexcom touchscreen receiver once it is approved and being distributed) outside of what is allowed by Medicare, you would likely have to go through a distributor who does not have a Medicare contract and pay as a cash customer. AFAIK that would be completely legit and above board. On the other hand the Medicare regulations are (at best) confusing so who knows.
Like with everything else we’ve experienced here - we’ll have to wait and see how it is implemented. I was immediately sent an ABN form where I checked off that I didn’t want Medicare billed and I was waiving all rights to appeal for Medicare coverage of any costs incurred. That done I was assured I would have access to hardware upgrades, supplies that fell within the limits of my doctor’s prescription. and no government oversight of my usage. But we’ll see. Dexcom has had their billing put on hold, for Medicare eligible recipients, since January, pending their approved coverage. They’ve been sending out “critical” supplies and not charging the patient. All this delay must be kind of painful for Dexcom.
According to the recent earnings conf call, the Medicare billing is not on hold and (as of the conf call) have sent out Medicare orders to patients as well as submitted the billing to Medicare. Dexcom is continuing to process Medicare orders but are being cautious until they actually receive reimbursement at which point they will ramp up.
I really do not think Dexcom would be allowed under existing Federal law to accept payment from you. Once they know you are Medicare eligible then I do believe that is not something which can be reversed. But you should still be able to go through a non-Medicare distributor as a cash paying customer so as to be able to achieve the same results.
Q2 2017 DexCom Inc Earnings Call
Tuesday, August 1, 2017 at 8:30:00pm GMT
"Last month, we initiated our first shipments of the therapeutic CGM bundle to initial group of Medicare eligible patients. The timing of our Medicare rollout is tracking with expectations, and we are working through the implementation process to ensure we put the right pieces in place to support the billing and fulfillment activities. This is a complicated endeavor and will take time to scale up. Assuming our initial reimbursement claims are successfully adjudicated, we will roll out our Medicare program more aggressively over the course of the second half of the year. The response to Medicare coverage in the field continues to be amazing, and our expanded field team is attempting to manage the significant demand we have experienced, along with customer expectations. By the end of the second quarter, we had approximately 20,000 new Medicare eligible patients in our pipeline, and we reminded you that we have not yet started to promote availability to this segment of the population."