United Healthcare Coverage of the G4

For those of you on United Healthcare, I just found out that they are now covering the G4 CGM under my prescription plan. I have the UHC POS plan through my employer. As of last year, CGMs were covered under durable medical equipment with a significant out of pocket cost. Now I pay nothing!!! Not even a copay even for the new transmitter and receiver. I just wanted to share since I was not contacted by UHC about this change. I just happened to have Dexcom contact my insurance who made the discovery.

Be sure and check with your plan I have UHC as well and mine fell under DME, the same manner as a Pump would. But that's wonderful that at least some of the plans are changing! If only I had been so lucky :)

Same here - ours is DME

Heads up tho - remember not all DME providers can bill Pharmacy - i.e. prescription, you may need to change where you order your sensors. Also I cannot order more than one box at a time, a "month's" supply under prescription drug. When I was covered under DME I could order 3 months (3 boxes) at a time. My plan does have a copay tho - will depend on your particular employer contract with UHC I believe.

Thanks for the info. My insurance was just changed to UHC and I haven't had a chance to get supplies from them yet. Copays for prescriptions go as high as 35% or $200 for 3 months supply for brand names that are not on the preferred drug list. Not sure what the copays for DME are.

I also found 2 pdf files on UHC's website which deal with DME and CGM (click on links). I guess I'll find out pretty soon how they interpret all of this :)

Does UHC make you go through a third party (like Edgepark) or can you order directly from Dexcom? (I am required to use Medco for prescription drugs btw.)

Lastly, I have working Dex 7 hardware and I am very happy with it but I might be forced to upgrade to G4 because of the need for new sensors...

When the company my husband worked for had united and my pump and CGMS supplies were all covered under the medical portion of the plan, I was able to order supplies from either the pump/CGMS company itself or go to a independent supply company (like Edgepark). I always looked for those "in network" to make sure I was getting the biggest bang for my insurance buck.
Now with this company he works for, still uses united but I now must order my CGMS through my prescription drug plan, life is a little crazy! Again I can use any "in network" for my pump supplies (i.e. directly from animus or from another provider such as Edgepark). However, many companies like Edgepark cannot bill for pharmaceutical supplies and therefore cannot cover your needs. Medco, my prescription drug provider does not stock CGMS supplies. They actually have no clue what a Dexcom CGMS sensor is! (that took 4 days of phone calls, trust me!)(to bad I didn't record them - I finally had to tell a senior pharmacist at Medco to "Google" it!) So finally Dexcom said call Diabetes Speciality Center (DSC) - problem solved. I now order all from them, they bill both the medical and pharmaceutical portion of my plan. Two seperate sections to order from, but so far no denials or problems with billing. One nice thing about having to get my Dexcom supplies thru the pharmacy, DSC tells me when I am on the phone with them and they place the order if it is approved - it's instant - so if i call in to soon, we know. Or when my Dex 7 rolled belly up and died, DSC was able to tell me that I was approved immediately when I called to upgrade to the G4.

I get all of my supplies from Diabetes Specialty Center and not Dexcom. That is just where UHC has always told me to go. I do wear the OmniPod and that comes from Medco. Even though you don't get supplies directly from Dexcom, I would contact them to figure out your coverage. They are great about dealing with the insurance companies and finding out exactly what you have to do and what it will cost.

I too have had a good experience with Diabetes Specialty Center. Very helpful customer service reps that are familiar with the needs of type 1 diabetics.

This is now the case with our UHC plan as of Jan 2014. It used to be under DME, now it is thru pharm. I keep calling and they keep putting me off. I had the endo fax the claim numbers… I got a letter it was covered, then another saying it isnt. I already opened the $1600.00 boxes of sensors. This is BS.

When I had problems back when hubby changed jobs, UHC had approved my sensors. I ordered, claim processed thru DME portion and then denied. I began working with UHC to attempt to help me solve the problem. However, it took me actually calling my husbands company and tracking down their benefits coordinator to solve the problem. It took forever but the end result was my claim was paid. Maybe you will find success if you speak directly to your company’s benefits coordinator. It took me a lot of work but it paid off for me in the end. Good luck!

Thank you. I will do that. I followed up and spoke to two different people twice, and was told wait ten days. Why should I need to wait ten days for something that we have been getting for over two years, no job change, no insurance change that we made? And I am getting double speak. I may have my husband call, since men get taken more seriously than women. They should have let us know there was a change in coverage. Also, dexcom is durable medical equipment, and should be covered thus. But I dont care how it is covered as long as it is covered. Thanks again!

To maybe help you - based on what I learned. Generally UHC (DME) covers sensors, it’s a “normal” item to cover. However, for whatever reason employers have moved this item over to be covered as medicine - (cracks me up! I can live without my Dexcom I can’t live without insulin so which is medicine? Lol!) UHC DME section is probably not going to be able to help. They could not for me when I had problems. So contact the highest person you can get to in your employers company. Don’t take no for an answer. Google is wonderful at finding corporate phone numbers btw! Ask for UHC phone records and other files to be reviewed by your employers health benefits supervisor - as long as you are sure somewhere in those records there is proof that they said yes it’s covered. It’s how I won my complaint back when I had problems. Don’t give up. We must fight for our benefits theses days! Good luck!

Thanks so much!! Oh I wont give up. I am very nice and polite, but very tenacious. We have the persons name and number and email of the HBS because our son was dropped from insurance due to a glitch in Jan 2014 (talk about a laxative)!!! I could not fill the Lantus!!!. But they were very nice and we got it straightened out with a few emails and calls. Its like trying to get through to the friggin Wizard of Oz to get through to the actual person who gets on the stupid computer and presses the buttons on the freekin keyboard and fixes this stuff. TEN DAYS? Seriously? I am not sitting here waiting ten days. We had this stuff on auto order and all of a sudden its not covered? Riiigghhht. Let me at em!!! I am a very calm cool person but don’t mess (and in my head I am not using the word mess) with my kids diabetes supplies!!!

Now as of June 1 2014, the cgm is again covered under DME. So it was switched to pharm Jan. 2014 Thru June, so those of us who ordered supplies during that window are going thru hell trying to get them paid for. I was on the phone for an hour with a supervisor. She said she would call me back in an hour and a half. But she did not. I have called them four times since April 10th to cover the sensors and been kind, patient and firm and have all my paperwork and numbers in order, and I cannot get this resolved. We have been using the dex with no issues since November 2012.