I paid totally out of pocket for the Dexcom 7 in 2007 and 2008. The same insurance company now pays 80% for the Dexcom 4. I was diagnosed with Type I DM in 1986. Even with 250 BG checks a month and doing 7 to 10 injections a day, my glycohemoglobin was in the 9s and 10s. After 3 months using OmniPod–covered 80% by insurance-- my glycohemoglobin dropped to 7.7 My insulin and 350 strips a month are covered at 80%.
I've forgotten if I replied to this or not, so this may be a repeat:
Our BlueCrossBlueShield Federal insurance covers my daughter's Dexcom (except for that annoying copayment.)
No, unfortunately my insurance (Medicare) pays nothing for Dexcom and its supplies. I pay entirely out of pocket.
After my deductible, Anthem Blue Cross Blue Shield:
Total charge for 12 sensors: 2,336.46
Provider (Edgepark?Dexcom?) responsibility: 1,337.70
Amount allowed by benefit: 998.76
Amount paid (by insurance): 54.96
YOU ARE RESPONSIBLE FOR: $943.80
They are supposed to pay 80% (of the allowed price) after deductible. It never seems like they do. Their EOBs seem wrong all the time.
This is likely a problem with Edgepark (is that who you use? I see them mentioned above) - they FAR overcharge/mark up and they are bad at getting insurance info correct. I will NEVER use them again, as long as I live. I can never understand why anyone wants to use them, since they notoriously mark up 200-400% on their prices, but I understand sometimes they are the only option an insurance company gives for an in-network provider.
Cash price directly from Dexcom for 12 sensors would be $1050. The above quoted price you gave goes to show how much Edgepark marks up.
If your insurance allows you to work with any other DME provider, you should look into it.
I have BCBS of Kentucky (though I live in WI) and my Dexcom is treated like any other DME....covered at 80% through in-network providers, after I've met my family deductible.
I was pleasantly surprised that it was approved immediately - I did not have to submit any BG logs, letter of medical necessity from my medical team, etc.
It turns out I hadn’t met my deductible fully with that prior eob info I gave. I have now met my deductible and Anthem BCBS should now be covering 80%. If my family total for the year goes above 16,000, then things become 100% covered. I guess that’s a fair plan. Premiums are expensive though. Either way, health care is too expensive in the U.S.!!
When I called Dexcom to order.
They said I have to call Edgepark.
Edgepark is the necessary supplier in many cases, especially if you have health insurance. It's like this: you don't call Pfizer directly for medication, you call Walgreens (the supplier). Dexcom does NOT want to deal with anyone's insurance deductibles, co-pays, etc., which is understandable.
Edgepark deals with your insurance company.
Ok, so I have had United Healthcare for the past 3 years, and I have to tell you, I have had to come off of Omnipod. Prior to my having the WORST insurance I have ever had, I had BSBC of Georgia through the job. They covered Omnipod AND Dexcom. I was about to be approved for the device, when I moved states. To date, I (again as mentioned before) have United Healthcare. The only options given to us through our job are for HSA plans which don't come close to covering pods for the Omnipod and dern sure will not cover the Dexcom or sensors. If you have any suggestions that would be great. My A1c's are now holdings at 13.6 (I know) it has been like this consistently. Taking suggestions! I am the sole provider for a 3 person family, so I don't have the funds to pay for all this stuff out of pocket. Please advise!
I have a Medicare advantage plan. I started on it about 16 months ago. So far, all my CGM supplies have been covered with no copay. It’s always scary with insurance and I hope this never changes. I feel for those who can’t get these covered because it seems to me, it is a cost saving as well as a life saving device. Preventing complications seems better than treating them. But what do I know.
Not sure what percentage they covered, but the receiver, transmitter and 2 months of sensors cost me $150, and sensors will cost me $30 for a 2 month supply.
Does Tri-Care help or cover Dexcom products? I only ask because my husband’s ex-wife is saying that she is paying $1,000.00 for his son’s diabetic supplies. She says " Tri-Care covers NO diabetic supplies of any sort". Can someone please help me??
I’d say this is possible in light of my limited experience in no longer accepting Tri-Care. Perhaps someone who actually has Tri-Care health insurance can chime in.
As an aside, my daughter is covered under her father’s (my ex’s) Federal BCBS. Relatively speaking, BCBS Federal is considered pretty darn good (read “sucks less than most others”) health insurance. That being said, copays alone on my daughter’s diabetes meds and supplies run well over $450 per month.
Honestly, the crap health insurance offered to our veterans and their families is a crying shame. They deserve much better.
Frank the same thing happen to me. When I turned 65 I was force by my State insurance program to make Medicare my primary and they would be my secondary insurance. This work out ok because I got most of my medical needs cover at 100% and my secondary insurance covered by prescription needs including the Dexcom. After a year or two when Medicare lock into the advantage plan I was force to move to Humana, which assumed all medical and prescription needs. Need I say more. Although I still pay a premium to the State Insurance Program I am now totally control by Medicare’s guidelines and you know they don’t cover CGM Systems. Pretty slick trick.
Bob