My efforts to maintain a “low profile” with respect to starting (again) the CMS/Medicare paperwork process came to an end yesterday.
I made my periodic call to get a box of sensors and my name has finally bubbled up to the top to officially process my G5 for Medicare coverage. Ugh!! I’ve been using CGM for well over 7 years having started with the Navigator then the System 7, G4 and now G5. Also been using pumps for 25+ years. I was diagnosed T1D in 1967.
The only item I’m not pleased with is the CMS/Medicare restriction on using my Smartphone so that my wife can also keep an eye on my readings as I sometimes get “busy” and ignore the alarms and she will call me and gently. but firmly tell me to take care of the low BG.
I am optimistic that this will be resolved over time, but that “feature” we use has been of great value to my well being overall.
When I saw where the Contour Next BG strips and meter were being used I got one and have been quite impressed with it. I’ve ordered test strips via Amazon and paid $46.52 for 200 strips. Not too bad.
I have been using the OneTouch Verio Flex and reasonably pleased with that meter and I have a huge supply of those test strips.
Since being on Medicare for the past 2+ years I’ve been on self-pay for CGM, so the change will be nice, but it sucks to lose the “follow” feature for my wife.
BTW - Dexcom told me yesterday that nothing will be ‘restricted’ with the transmitter, etc… Rather I was told that it was being done on an “honor” system and if CMS/Medicare did an ad-hoc review and discovered that I had been using the Smartphone APP then my CGM coverage would be cancelled, I would be billed for the product and possible get a fine for violating the agreement.
All my Dexcom contacts continue to be optimistic that the Smartphone restriction will be modified over time.
Great news, after five months my wife just received her Dexcom G5 package, and will start using it after receiving training from the Joslin Diabetes Center at our local hospital. Had it not been for the Medicare Ombudsman I don’t believe Dexcom would have acted so quickly without the lady from Medicare nudging them forward. Also, a Huge Thanks goes out to @Jason99 for his posting on this matter.
New wrinkle from Dexcom RE: Medicare requirements!
Dexcom will not allow a patient to re-order sensors if your endocrinologist has not furnished them with updated chart notes regarding office visits after you begin using the G5 CGM. Dexcom states this is a Medicare requirement in order for CMS reimbursement on sensors and supplies. This is just another hoop by Medicare for diabetic patients to jump through only adding to more frustration. My wife found this out the hard way after using the G5 for only one month! She had to call her endocrinologist to have them fax over her past 6 months of chart notes to Dexcom in order to comply. What a way to run a circus!
Was her first month under Medicare and had the six month records already been provided then? You’re the first person that I’ve read mentioning this. On the other hand there are not that many people already having a reorder shipment. And on the other hand, it is Medicare…
Yes, this was her first month using the Dexcom G5 after waiting five months
to receive it. Dexcom only provides you with four initial sensors she is
on her third sensor. So with only one left, and to be precautionary in case it
may fail she called to re-order more sensors from Dexcom. The Dexcom rep
said they could not fill the order because they only had her chart notes
from when her Endocrinologist first ordered the device back on 3/27/17.
However, she did see her Endocrinologist one full month before she received
her new G5 CGM. After so much haggling with Dexcom, I had to get a
Medicare Ombudsman involved to assist us with moving Dexcom off their duffs
just to ship out the original initial package because Dexcom was worried
about collecting their 20% that Medicare didn’t pay. My wife has secondary
insurance through the VA because I am a disabled veteran. Dexcom told us
they called the VA and were told by someone at the VA that they would not
pay the 20% co-pay. So that is why Dexcom was dragging their feet and were
going to send us to a third party supplier in Salt Lake City to get the
G5. We said what for? The VA is part of the US Government just like
Medicare is.
After we involved a Medicare Ombudsman, and myself having to call the VA
who said Dexcom lied because they NEVER called them to see if they would
pay the 20% co-pay in which they in fact do as long as the patient has met
their co-pay liability. In fact, I know disabled veterans who are
diabetics, and have CGM’s from Dexcom, and all are reimbursed @ 100% . So
Dexcom is Still on a long learning curve here in dealing with Medicare, and
collecting their reimbursements from CMS.
The Dexcom Rep offered to mail out two complimentary sensors so my wife
does not run short, and we are still waiting for them to arrive along with
her up-to-date chart notes being faxed over to Dexcom by her
Endocrinologist. I feel this is so much needless hassle, and the
frustration with CMS that continues to build! Hopefully, we will be the
Ginny pigs so others on Medicare don’t have to endure ALL these hoops &
hassles that my wife is going through.
With all that said, and as far as I’m concerned the G5 CGM is a God-send
in helping to control my wife’s blood glucose levels, and puts my mind more
at ease when I’m not at home, or she goes out with friends or family.
New here, and a new user of Dexcom since the Medicare approval. I rcvd my “Medicare” Kit mid Sept. I had been reading about the smart device restrictions, trying to understand the reasoning (or lack thereof) and trying to figure out how Medicare would know if you’ve used a smart device. I could not find an answer anywhere. I went to my regular endo appt on 9/14 and had a long convo with my drs nurse who had been processing all the Medicare paperwork for months. She explained to me that in order for Medicare to continue to ship supplies, they were requiring visits every 3 months, where your receiver would be uploaded. After she (the nurse) uploads the receiver, she is required to send the data to Medicare. At this point, they could tell whether you have linked your transmitter to a smart device, they could see when you are changing your sensors, etc. For those of you who have been on Dexcom prior to Medicare approval, this upload would be done wired to the receiver (obviously u don’t want to do the wireless upload). Now like I said, I’m brand spanking new to Dexcom, and I don’t have the techological understanding of how it can be seen that a transmitter/receiver has been used with a smart device, but for the seasoned users, maybe you understand. And as for Big Brother Medicare, with the massive amount of new patients rolling out on Dexcom since the Medicare approval, I can’t imagine how that information could be sorted through.
Do we even know if the Medicare receivers can be used with a smart device? I read (sorry, I cant remember the source to link atm) that the change occured at the app level. I’m certainly not going to risk it, but I’ll be listening and will continue to search blogs/forums/FB groups as it is inevitable that it will be tested.
For me, I felt like a kid on Christmas morning when my package came. Smart device or not, I’m thrilled to finally have coverage and no longer have to scour FB groups for free or expired Minimed sensors to use with my Mini Link transmitter. (Yes, it miraciously still functions after nearly 3 years of very periodic use lol) My dream is to get the X2 and be able to use it with Dexcom…hopefully that will happen sooner rather than later.
And hello! So happy to have found this wonderful forum!
@Angela017 - Congratulations on receiving your Dexcom starter kit. The technology is great and provides a great deal of information to allow you to really have a much better understanding of what is happening.
In terms of when you speak of the Dexcom Receiver being uploaded and allowing Dexcom/Medicare to know if a Smart Device has been used, this is hard to know if that is true but it sounds to be within the boundaries of possible.
When using the Dexcom App on a Smart Device, data is transmitted from the Smart Device via the app to the G5 Transmitter. This data is then transmitted from the G5 Transmitter to the Dexcom Receiver. In particular, this is data such as sensor start/stop, calibrations, etc… The G5 has two-way communication. For example, when using both the Dexcom App on a Smart Device AND the Dexcom Receiver at the same time, you very specifically are NOT supposed to dual-enter a calibration into both the Receiver and the App but rather enter the calibration into ONLY one or the other. In less than 15 minutes (usually quicker in our experience) the calibration shows up on the other device (having been routed through the Dexcom G5 transmitter). This is factual.
Is the date/time of when sensors are started and stopped recorded? Yes.
Is there any unique identifier on a sensor to be able to determine if the SAME sensor has been restarted? Absolutely no indication or any hint of such. Presumably this is not possible to determine.
So, (now into the realm of speculation) is it possible that when the data transits from the Smart Device through the Transmitter and into the Receiver that an additional data element is carried along that indicates the presence of the App running on the Smart Device? Sure - it seems feasible from a technology point of view. Whether this is implemented and actual is an open question AFAIK.
When you ask about the Medicare receivers being used with a smart device, I assume you mean the Dexcom G5 Transmitters (obtained via Medicare) being used with a smart device. Although there are rumors of the Transmitters being crippled in this regard, there is so far no evidence and no end-user reports of such crippling taking place. In fact, Dexcom is actively asking Medicare recipients to NOT to run their Smart Device against the Transmitter. There would be zero point in such communication if the ability had already been blocked.
The path your data takes is well documented. If you are (not on Medicare equipment) using a smartphone with the Dexcom app that app uploads your information directly to Dexcom and can be seen when you use the Clarity app or visit Clarity on the web. Many people, again not on Medicare, never take their receivers out of the box or turn it on. Or you can do as Medicare insists and only use your receiver to capture the transmitter’s data. This will then get uploaded, via your computer, to the Clarity website so you can see your data. Your doctor’s office goes this route as well. And some people use both their receivers and their smartphones depending on the circumstances. In this case the info gets seamlessly woven together. But, Dexcom knows the path that data took. At the bottom of your Clarity report it even shows the user the last time each, receiver or app, was used. Here is a photo showing my connection history. I stopped using the app on August 4th in anticipation of receiving my Dexcom/Medicare shipment.
You don’t tug on Superman’s cape, you don’t spit into the wind, and you don’t want to risk losing your Medicare benefits for CGM because of using a smartdevice as a receiver.
Kind of an add on to the problems associated with this Medicare ruling - if you are using a Mac and have updated the operating system to High Sierra - it’s very possible the Dexcom Clarity uploader is now broken. I spoke with the techies at Dexcom the day after the update was released and they admitted they aren’t ready for USB 3 and High Sierra. Yuck. So I’m kind of stuck at the moment.
Thanks for the info. I have no intention of messing up my long awaited Medicare CGM eligibility/coverage. I’m just a curious cat who is enjoying researching and trying to fully understand the ins and outs of all this stuff. I feel so far behind and out of the loop with the latest developments, so I’m happy to be here and learning about everything!
I’m guessing part of the issue is that Medicare has an obligation to insure that you actually use the sensors and don’t resell them and hence, profit illegally from govt $$. Sadly, potential fraud forces illogical processes to be required.
Unfortunately there are some that wish to take advantage of the “system” to make some extra profit, or get something they believe they are entitled to. However, that is why Medicare is placing a lot of these restrictions on seniors for this G5 CGM. FYI: We were informed that your doctor will be required to download the information from your G5 receiver on a quarterly basis, and fax that info to Medicare. Therefore, this is also one of their possible reasons why they don’t want patients using smart devices to collect, or store the data. Its another way for Big Brother to keep (pardon the pun) a watch on seniors!
This is complete fiction. The only requirements Medicare has in place are that you see your doctor every 6 months, they document that you are in fact using the system in your chart notes. Of course, a new prescription once a year. There are a lot of doctors out there that don’t want to deal with downloading diabetic devices, most seniors wouldn’t know how to do it themselves. Dexcom’s website has a comprehensive list of the qualifications for the G5 with Medicare, submitting a download of the receiver is not one of them.
Jason—Right now different seniors are being told different things by different Dexcom reps and reps of other suppliers. Ironically if we were allowed to use our phones, our data would be automatically sent to Clarity and there would be a record of our use. However, I think that HIPAA protects our data there somewhat but I am not sure. I do know that Dexcom is working hard to ensure that seniors follow the regulations so that Dexcom avoids audits by Medicare and that we don’t jeopardize Medicare CGM coverage.
I have heard people who were on Medicare during the early days of insulin pump coverage say that it took a while to get all of the wrinkles worked out. I like to think that ultimately smartphone usage will be allowed because of the value of the Share/Follow function. But as someone who thought a year ago that I would have to self-fund my CGM, I am pleased that we have gotten this far.
But the process is still not smooth for everyone and there continues to be some inconsistency in how orders are handled.
Laddie- I agree with you. I think we have to take everything we hear with a grain of salt. If this rumor of having to give a download of the receiver to Medicare had any traction, you could bet that Dexcom would have it on their website under the Medicare guidelines. I’m still not convinced that there is a reasonable understanding of the use the receiver only rule. I can understand why Medicare doesn’t want their patients to use their phones. I think it’s stupid, but I get it. Why rule out insulin pumps, which have the same warranty period as the receiver and are classified as DME? From the info I got from my Tandem rep last week, they are not getting involved in this fight and letting Dexcom handle it. I do not agree with that decision, because the only way this decision gets overturned is if Medicare gets blasted from as many sides as possible for this ridiculous move. I’m following this very closely because whatever Medicare does, most insurance companies tend to follow after a while. I’m hoping this is one decision that doesn’t gain any attention outside of Medicare.
I have enough supplies to last until January or February when I will have to start following Medicare rules.
My understanding of the Dexcom transmitter Bluetooth channels is that one is a receiver and one a smart device connection. So I can’t use my Tandem X2 in addition to the Dexcom receiver. And Tandem notified me in their latest customer email that the X2 is not approved by Medicare to be used as my Dexcom Receiver. When I read the Medicare criteria, it only outlaws smart devices and does not mention insulin pumps that are approved as DME.
Frankly I hope that all of this gets figured out in the next couple of months. I do know that if I do anything other than just use the Dexcom receiver, I will not be sharing it on social media. I used a Dexcom Receiver for many years and I know that I can adjust to using it again.
Jason, I’m sorry, but I’m not a fiction writer, and I don’t even like fiction, I deal in facts. I’m an Advocate for my wife. I’m reporting what as @Laddie stated above of what was told to us by a Dexcom Rep. If you don’t know by now, I personally don’t care much for Dexcom Corp, and their complete bungling of distributing their G5 device to seniors since March of this year. Starting from outsourcing the G5 to finally taking on the distribution task theirselves in August. However, there is one person that posts on this forum on how much they just love Dexcom, and owns their stock. I myself wouldn’t invest a dime in this company because of their poor customer relations with this senior, and ALL the hoops they’ve made us jump through. FYI: Here is an email we received just the other day from Dexcom after I questioned the Supervisor for Sales in the Ohio Valley about re-ordering supplies for the G5 CGM:
“No, your wife will only have to deal with getting Chart notes every 6 months, and a new CMN every year. It looks like we do have her 7/24/17 office visit notes on file which should be good until November.”
Can you please tell me why the Decom Customer Service Order Rep told my wife she couldn’t order any supplies until she called Medicare? So we called Medicare, and they informed us WE should not be calling them. The provider/Dexcom is the one that should be in contact with them regarding supply issues! I don’t make this this stuff up as fiction.
Also you stated: “Why rule out insulin pumps, which have the same warranty period as the receiver, and are classified as DME?” Well, I beg your pardon sir, NOT ALL insulin pumps are classified as DME. We have been fighting CMS for the past 3 years over the Omnipod Pods that are NOT classified as DME, but rather tubing for tube type pumps is a reimbursable expense by CMS! You can ask the VP of Marketing @ Insulet on how I feel about this matter as we have had quite a few discussions on this topic, and are still waiting for CMS approval.
As I have stated previously, I also understand that there is a learning curve that’s going on here between Dexcom, and CMS, but Dexcom has been so lax in this arena it isn’t funny when someone’s life depends on these devices. As @Laddie also so well stated, and I completely agree with, and happily quote her; “I refuse to get in a situation where my health and sanity is in jeopardy because Medicare and DME suppliers don’t understand that my life depends on this stuff, and my supplies are not a luxury.” Dexcom has a lot to learn in the Customer Relations Department, and should be at the top of their most prominent objectives! JMHO!
