one month ago Dexcom told me they were now "out of network" for my BCBS insurance for sensor reorders and referred me to "Diabetes Specialty Center" in Utah who has turned into a nightmare.. after telling me for the last two weeks they have "sent six requests" to my doctor and "called my doctor numerous times" but my doctor will not return the prescription form, I went to my doctor's office today to find that no one from Diabetes Specialty Center has faxed or called them at all.
so, even with my now daily calls to Diabetes Specialty Center (voicemails are not returned) getting no results, since I'm on my last sensor I need to forget Diabetes Specialty Center and find another BCBS In-Network provider who does very fast turnarounds to start over with. can anyone with BCBS insurance give me any suggestions? THANKS Biff
We use Diabetes Specialty Center and have excellent service. I'm sorry you are having such trouble. I think you should call Dexcom and ask them for help. If there is another in-network provider for you, they'll know about it. Also, definitely tell them about the trouble you are having with DSC. Dexcom needs to know if a distributor is not providing good service.
thank you, I will call Dexcom on Monday, but since their first referral hasn't worked out, I thought I'd people's personal recommendations. glad you had good luck with Diabetes Specialty Center.. I was initially very impressed by the polite DSC woman I am dealing with, especially since she wanted me to have her direct dial number, but at this point it's just ridiculous she's told these stories about having talked to my doctor's office when she's never contacted them, and you have to get her live on the phone because she will not return calls.
by the way, has Diabetes Specialty Center been supplying you with order status and tracking information? they told me once the order is placed they will not be able to supply tracking since they are "ordering through Dexcom" (which is what I want to keep doing BCBS!)
thanks, Dexcom has always been in-network with my BCBS Anthem insurance, but when I called Dexcom to reorder sensors last month, Dexcom said BCBS in October had declared them out-of-network. I even called back someone else at Dexcom to double check and was told the same thing. but you are correct, I should ask again (and again). I've leanred it's often helpful to ask the same question to a number of different people to see if you get a variety of answers. thanks.
I have also had excellent service from Diabetes Specialty Center in Utah, They have practically gone out of their way to make sure I have sensors and time them perfectly so my insurance covered them 100%.
I have Anthem BCBS in NY... I can't get fulfilled via Dexcom directly for sensors, but have to go through Edgepark. Interestingly, the sensors are sometimes shipped directly from Dexcom, but billed via Edgepark!
This may or may not seem obvious but have you considered appealing your BCBS decision regarding Dexcom being out of network? Many people don't know or forget this option even exists. I have used it several times for different things and have won every time.
Case in point, I started using Dexcom shortly after the System Seven came out (before the Seven Plus). At that time Dexcom was considered out of network for CareFirst BCBS of Maryland. I appealed the decision in writing per CareFirst's instructions. I explained the Dexcom would help to improve my diabetes control and would potentially reduce the chances of diabetic complications and higher medical costs in the future.
You could also explain your BCBS plan's referral to "Diabetes Specialty Care" and all the problems you have had with them. Be very specific with your details.
I won by appeal many years ago and all my Dexcom equipment and supplies are covered.
I have had the same issues. The first several calls they had “just received” the script from my doctor. My doctor sent them the script the first Time DS called. Then all they needed was pre certification from Anthem BCBS and that would only take 48 hrs. It was just another 48 hrs each time I called DS. They did not know that I was in touch with Anthem and had no record of DS requesting the pre cert. BCBS does not need pre cert for durable medical devices prescribed by a physician.
Even when BCBS called DS and spoke to the rep explaining it was covered 100% and did not require pre cert, DS still claimed they need approvals. Finally a rep from BCBS found that DS had the wrong billing code. It was corrected and DS called me to let me know they are shipping the insets for my 7+. That was Friday. I’ll post if I get them or not next week.
BCBS was my advocate in getting this straightened out. They are not the stereotype insurer you must be protected from. They were enthusiastic and helpful when I started pump therapy and great in the years following.
We have Anthem BCBS and use Neighborhood Diabetes. You do have to follow up with them and the doctor, but they get it done and are very nice. If you tell them it's important and a rush, they should be able to handle it.
No, we never get tracking info from them. That's the one thing I don't like about them. We were with Edgepark initially and I think they had better communication regarding shipments. However, we had such terrible billing issues with Edgepark that we called Dexcom asking for a different provider and they told us that DSC was in-network for us. They aren't really recommending one or the other, but they know which distributors are in-network for your insurance plan. I suspect that either of them can be good or bad depending on your luck. :(
isn't that amazing?? Diabetes Specialty Center also said they will "order through Dexcom" (and not be able to supply any order or tracking information because of that). I don't know whether BCBS dropped Dexcom like Dexcom says, or whether Dexcom is now refusing to accept what BCBS wants to pay them, but it does seem odd how anyone, Dexcom, BCBS, or especially I will benefit from an additional third party being thrown into the mix.
thanks for your information.. this sounds so much like the runaround Diabetes Specialty Center has given me over the last three weeks. what I cannot accept is the untrue things they have told me about having sent the presciption they need "six times" to my doctor and "we've talked to them countless times." I knew that was untrue since I've been with my doctor for over 15 years and his office has always without exception faxed back prescrptions within a couple hours at most, so it was no surprise when I went to my doctor's office and learned no one from DSC had ever contacted them even once.
tomorrow morning I might call Diabetes Management & Supplies, and if they are BCBS in-network see if they can get my order handled in a day or two (and send tracking information) like I've heard people say. since Diabetes Specialty Center has wasted three weeks of my time, I'm now on my last sensor, and I'm so dependent on these Dexcom sensors that I'd be afraid to go to sleep or leave the house not wearing one.
thanks Mike for the recommendation, I might try them tomorrow also, and see if they can process my sensor order in a day or two.. since Diabetes Specialty Center has wasted three weeks of my time on this, I'm on my last sensor and am starting to get nervous. I might have to call Dexcom tomorow too and see if they will just sell me one sensor and overnight it.
Just food for thought -- Liberty Medical is a subsidiary of Medco Health, the company that was dropped by Federal BCBS because of claim mismanagement. This was the reason for the big mail order pharmacy change.
THANKS everyone for the responses. after giving up on "Diabetes Specialty Center" after they could not process my order in THREE WEEKS, I called Dexcom back this morning, and the Dexcom rep told me that Dexcom is now back in-network with some of the BCBS plans that made them out-of-network in October, including my Anthem BCBS "in certain cities/counties in the state of Virginia" including mine. so she got an immediate confirmation and shipped my sensors out same day. whew. things worked out for the best.. thankfully Diabetes Specialty Center dropped the ball just long enough so I can keep ordering from Dexcom after all. tracking information in my email box.. thank you Dexcom !
