This is helpful. The best of luck with it! I know the pump is important to you, but not as significant in managing T1 as CGM in my humble opinion. Glad you are getting CGM - it will do wonders!
Happy you are well taken care of! That is nice.
70% on DME is paid by my insurance.
Was it hard to get approved by your insurance?
My insurance company covers the Dexcom 100% without any copay at all. United Health Care covered the device and senors in full.
That's a good deal. Thanks for your entry.
I was told directly from my insurance company that they dont. I am using edgepark for my diabetic supplies and my rep was able to get it covered.
The way the USA is, the health insurance IMO wants us to die than to keep us healthy. I cant even get the ketostix covered as their is a restriction of the max age of 161). You figured ins would LOVE to make the $$ off of it and cover it. But not all insurance is the same
I actually am trying myself to figure out how to get the change in place. Not sure who I would write to either
At the retail cost of the Dexcom, I doubt many folks -- in the circle or out -- could afford to pay for a Dexcom. Richard is the only one I know of. There's just too many other necessary things -- I dunno, like INSULIN -- that might take the place of getting a CGM.
In any case, my situation notated above changed today...
I just got hit by a bill from CareCentrix (Cigna's billing agency) for the cost of the sensors for the first time in the nearly two years I've had a CGM. I called into Cigna about this, and was told the RECEIVER is covered at 0% ded./100% coverage as DME, but the SENSORS are NOT DME and never should have been, and thus should be charged at the 80/20 rate of all other med supplies. Fortunately, Cigna is not going to go back and charge me for all my sensors over the last two years since they consider this their mistake, but I am now paying the 20% co-insurance cost on all new sensors. Also, my $450 yearly deductible will apply. Ouch.
So, I will now join the ranks and start wearing my sensors for 40 days and 40 nights (or as close as I can come to that) in order to lower my costs. Wish I did not have to do that -- I do not like keeping something plugged into my body for that long -- but that's the way it goes when we do not have any sort of National Health program here in the U.S. (yeah, I'm a fan -- always have been).
/\/\
I did get approval for the G4 sensors. Unfortunately, my $1000 deductible will apply first. After that, the insurer will pay 70%, and I will pay 30%.
As I understand, sensors will cost you $450/year. Once you pay up the deductible, they are free. In a sense, most diabetic patients probably pay in medical expenses the deductible yearly anyways and, after that, receive meds and supplies free. It may be that for most diabetic patients your current situation still would imply no overall yearly increase in out of pocket expense. Does that make sense or am I missing something?
TracySue, could you share what insurance do you have? Regards, Mark
My current sensor is on day 27 and still giving excellent readings. I got 12 sensors on February 19th and currently have 3 of them left plus one that was replaced by Dexcom. So in almost 6 months I have used 8 sensors. If I were paying out of pocket for it and getting the same amount of wear time, I would definitely count it as money well spent.
Thanks for sharing your experience! I am so glad you were able to get the G4 - it's a must-have tool! Mark
Behind frustrated - G4 Platinum was covered last year as long with the sensors. I went to order new sensors in 2013 and a new transmitter as mine died. I was told only the unit and device was covered, sensors are no longer a "medical device" and it should be under express scripts. Express scripts tells me its a restricted device and not covered.
■■■■■■■ great, had to pay my deductible to get the platinum and transmit tor but can't buy the sensors unless over the counter (300 a month)
I have BCBS-MA....really upset at the moment.
Dexcom and Medtronics approached the FDA together when they went for approval on their CGM systems. They worked a deal with the FDA so that ALL pieces of their systems would be covered as DME (Durable Medical Equipment), even though it is clear that the sensors are not specifically DME (no one else can use a sensor after you have used it, obviously, however anyone can use a Rx and a Tx that have been used by someone else). Knowing this, I would approach Dexcom and get them involved. They might be able to help.
I ran into the same sort of thing this past year when Carecentrix (the billing arm of Cigna) tried to make me pay for the sensors since "they are not DME since no one else can use them" (their words). After many phone calls and negotiations with Dexcom, Carecentrix and Cigna, everything worked out in my favor, but it took two months.
Dexcom told me they had a contract with Carecentrix that specifically stipulates that their system is entirely DME, even though the sensors are not specfically DME. Yet some bright light bulb at Carecentrix made their own decision (which eventually proved to be wrong) to treat the sensors as normal pharma, so I was billed.
So call Dexcom and tell them what's going on. Good luck -- let us know what happens.
/\/\
Hi all. New member here. I know this is an older thread, but the poster's question relates directly to what I am dealing with now. I am a newly diagnosed type 1, and I have spent a number of hours over the last few weeks reading conversations on the tudiabetes forums. I am currently on MDI (would love a pump buy my insurance company, Coresource, has denied a pump until I provide them with 6 months of MDI logs that "prove" that I need variable units of insulin). My insurance has also denied coverage for a dexcom cgms because I am not over 25 and have not demonstrated lots of lows that have required outside assistance (even though I have had over 20+ lows in just the last month and a half). Of course, I am appealing to the fullest extent possible. I would love any tips on successful appeals. All of this is just frustrating, as I am attempting to maintain tight control of my bs levels. I have purchased the dexcom out of pocket for now, but I am 22 and a master's student and the long term sensor prices are just out of my reach. Hopefully, the appeal process will reverse the original denial so that I can be reimbursed.Fingers crossed. It is just crazy that this kind of run around is required to receive coverage for such beneficial technology.
Welcome - and I am sorry you are going through the insurance run around. First thing I would say is enlist the help of your endocrinologist. Document your blood sugars carefully and if you can download your blood glucose readings to your computer it helps at least with the bookkeeping part. I wear my Dexcom sensors at least 2 weeks, but more often than not I wear them 3-4 weeks with good accuracy. Also have Dexcom and whatever pump company you choose do the work for you. Find out who your local Dexcom rep is and have him/her contact your insurance, endo etc. Dexcom folks want to make the sale and are more than willing to do the work on your behalf. They also know exactly how the forms need to be worded in order to get covered.
Insurance fully covers my device. And my insulin pump as well.
Hey Clare! Thanks for all of the advice. I have been working diligently to document my BG readings, and fortunately I have an awesome team through my endo and dexcom rep who are both working hard to get me what I need. I just recently added a new health insurance plan to the mix, so hopefully they won't be as resistant to paying for a dexcom. We will see!
I previously had Oxford Freedom and they covered it 100% after meeting my deductible. I was forced off Oxford and onto Affordable care act plan through NYS health exchange- United Health Care Compass. At first it was covered at 70% after I met my deductible. then they rescinded my approval after paying for them for 4months for no stated reason. Then they told me I needed a referral from my dr under NYS law but that they had no process in place for medical device referrals (only specialist referrals) so they had no way to process it so they couldn't provide it to me at all because they didnt have the procedures to and not because they wouldn't (I know this makes no sense). Then all of a sudden they processed it as prescription item with a $0 co-pay. Hope this helps