This is nuts!!! Has anyone come across this situation recently?
Background: We have a UHC POS with a $5K individual deductible. We also use a HSA but between all of my family healthcare expenses, it gets used up quickly.
In February, my son received his first order of CGMs using our new UHC insurance. The price for 3 boxes of sensors was billed at $2268.75, with plan discounts of $1260.75, so we paid $1008 as our deductible. When I went to re-order in May, the exact same 3 boxes of CGMs were billed at $3750, with plan discounts of $1980 and a deductible of $1770. Thatās an insurance price increase of $1481.25 in 3 months, which equates to $762 extra for our cost.
When I called UHC, they told me that price also included: 3 āDexcom CGM Supply Kits Per Monthā. There was NOTHING else included in the shipment. Apparently, this is just a change of name but every time I talk to someone at UHC, they tell me that the shipment includes 3 Dexcom Supply Kits as well as 3 boxes of Dexcom sensors. Baloney!!! Dexcom cannot help me as UHC have their own names/descriptions/item# for these products. So essentially, I am paying an extra $762 for 3 months of āairā that they bill as Dexcom Supply Kits. I am so frustrated that Iād prefer to buy directly from Dexcom but once I pay this bill, we will have satisfied my sonās deductible and we able to get the next two CGM shipments covered 100%. Anyone want my āairā that I am getting each month. Iāll ship them to you for free UGH.
I am suppose to use a preferred provider for my supplies. Call preferred provider in April, say need to order transmitter only. (Had sensors stockpiled). Provider says āoh UHC now sends out a 90 day supply (which means 3 boxes) of sensors WITH the transmitter every 3 months.ā OK, send. Billed to UHC, nothing happens, nothing happens, etc. etc, etc. Now July, need new transmitter but UHC still hasnāt paid for first order over 3 months ago. Get provider to send me one box sensors and transmitter, I have no clue what I will owe, when it will be paid or not, if Iām going to be out of pocket well over $5000.00 for these supplies. Oh and provider says its a problem with ācodingā with UHC. So yes, I am so frustrated with UHC this year I am ready just to private pay for everything!
I donāt know for certain but I believe this type of office exists in most, if not all, of the 50 states.
I think what UHC is doing in your case is fraudulent. Insurance companies have so much power and money these days, I would not be surprised, however, if they can legally sell you air for thousands of dollars!
I wonder if the word, ākit,ā was originally associated with the Dexcom bundle that includes sensors, transmitter(s), and a receiver. You might ask UHC what the cost would be for those items bundled together.
Thanks Terry - thatās a good place to start. Itās unfortunate though that I cannot reorder supplies until I have paid the outstanding invoice for the āairā
I have double and triple checked the invoices and I was billed and received the transmitters separately so there is no way these are included as part of a āKitā and it shows on the invoice that there were 0 CGM kits mailed with the 3 boxes of sensors!!!
I will persevere and try to get this figured out!!
Do you have an employer based plan? If so contact your HR dept or whoever provides you information about your employers options. They often have contacts to directly call UHC, and get through all the red tape to understand the rules for YOUR plan.
I had to do this several times with Caremark mail orders, when their system was not correctly handling the rules of my employer specific plan.
I have been searching the website for UHC as their support staff are not helpful. The code A9276, which is for the Dexcom CGM sensors has been replaced with K0553. The price for K0533 has been renegotiated between UHC and Byram (the only supply company I can use, of course). So the extra $760 I was billed in May represents their newly negotiated price. Donāt think much of their renegotiating skills. UGH. Now I have to go and pay $1745.43 in order to re-order supplies.
Medicare recently started covering Dexcom G5 CGMs. It uses the billing code K0553. I believe that code covers a kit that includes sensors, transmitter, and 150 glucose test strips. Is it possible that this new Medicare code somehow got mixed up with your case?
Hi Terry, just received DEXCOM 5 kit covered under Medicare and supplemental AARP United Healthcare. The supply company is Byram. It did not, however come with the Contour Next Meter and strips.
Called Byram and was told that they donāt carry that meter at all. She said they have a meter called Jazz?? and only supply to those on pumps. After explaining that I am on pump she went on to say that most people using Dexcom donāt need or want to do fingersticks.
Totally annoyed with the absurdity of it all and will call Dexcom tomorrow.
The Jazz meter my Agamatrix is actually pretty good, by the way. Itās essentially the same meter that is used by One Drop (and uses the same strips). There are of course options currently available by several companies that are pretty affordable and do not need insurance. Those include One Drop, Dario and AccuChek (via their SimplePay program), and depending on how many strips you need per month and on the amount of pre-payment you want to do, you can pay as little as $20/month for unlimited strips and more (myDario annual plan, currently).
JoedyRose-
Iām on Medicare with a supplemental plan and receive my supplies directly from Dexcom. Is it possible for you to do this and cut out the middle man? Iāve had nothing but pleasant experiences dealing with Dexcom.
My initial package from Dexcom included: 1 transmitter, a touchscreen receiver, a 4-sensor box and a 1-sensor box (weird but OK I guess), a Contour Next One meter kit, two 50-count boxes of Contour Next test strips, a bottle of Contour Next control solution, and a 100-count box of Microlet lancets.
Thank you, Calderons GD for responding. The starter pkg you received from DEXCOM is exactly what Byram sent me, minus the Contour Next and strips.
Iāve yet to use the Dexcom and spent well over an hour on the phone with them yesterday, being transferred to different departments, but all to no avail. Bottom line is that they have no plan under UnitedHealthCare that will cover the Contour Next. Not understanding as I know that UHC has a good many plans available for Medicare recipients and the one I chose is not cheap by any means.
Iām not giving up those. I will call Dexcom direct tomorrow or Tuesday. It would be great if I could bypass Byram.
Contacted Dexcom re not getting Contour Next I did ask if it were possible to get all supplies and rep is checking on it. Said itāll probably take at least a week or so before I learn anything.
Not happy with Byram at all, although they say itās because of Medicare & my supplemental insurance that wonāt allow for the meter, etc. Iām so not understanding it all. My UnitedHealthCare plan is Plan N. It cost $186 per month. I live in New York and perhaps that a lot to do with it.
Incidentally, I made sure Byram used code K 0553. They said yes, but doesnāt include meter.
Hoping Dexcom will allow me to purchase āin houseā
If so, Iāll have good news to report.
UGH.
