What would you do?

I'm not sure there's anything to disagree about. I fit exactly into the group you describe: 2 weeks ago, I received a new 7+ after the yearlong warranty on my old 7+ expired; insurance covered that. However, since the acquisition of my new 7+ is within the 30-day window, insurance will, in fact, also cover the upgrade. It was made clear to me that if I had not been within that 30 day window, I was free to pay out of pocket for the upgrade, but insurance would not have covered it. In that case, I would have waited a year for the new 7+ to go out of warranty, and then the G4 upgrade would have been covered.

So I don't know what you mean when you say insurance "isn't involved." It's absolutely involved in how Dexcom gets paid for the new units, if at all.

For new, first-time customers, pump and CMGM makers might be more willing to "give" the system away, since that brings them new customers in a competitive market. My first Dexcom unit, the 7+ was paid for however (insurance). I would point out, though, that I still had to give the insurer a strong justification for switching from my Medtronic CMGM in order to get that to happen.

The bottom line is that Dexcom needs to find a way to be paid, by somebody, for as many of its devices as it can, while still expanding its market share in a competitive niche. For most current and potential patients, insurers hold the purse strings and their decisions will impact Dexcom's policies.

Thank you for the suggestions - I mean that. The local rep won't call me back because she won't talk to any family or patient under the age of 18 with the Dexcom, per the rules. (That, in and of itself, is frustrating.)

However, I like your idea that if the range doesn't work that maybe they will accommodate something for that. I also told my husband previously that as long as it comes out after January I can resolve myself to that, but the fact that it came out soon after my order really steams me. If I had known with any kind of certainty - say even 50-60% chance - that it would be Sept-Dec I would not have placed my order. And yes, the FDA sucks but at the same time the FDA's decisions do not affect how Dexcom handles or manages their customers.

Here's some zingers from Dexcom reps / customer service (more for comic relief):
1. "It's just like with any new technology. My husband bought me an ipad for Xmas and a new one came out a few months later, and we had to choose to pay for that." Wha?!? My child's health is NOT an IPAD, and it certainly isn't a CHOICE.
2. "You're lucky we have an upgrade program at all." Yeah, somehow I'm not feeling so lucky. Especially when I have an Omnipod that has promised to upgrade everyone for free when their new one comes out, no matter when you purchased or your warranty.
3. "We don't design our products for children." You have heard it's also known as JUVENILE diabetes, right?
4. Me: "Do you have children?" Dexcom rep: "Yes" Me: "Do they have type 1 diabetes?" Dexcom rep: "No, I would die if one of my kids had type 1 diabetes" Word for word - no joke - DIE. OK, so don't presume that you know or understand what I am going through, and how this affects me and my family. Not to compare to Omnipod again, but I have actually spoken to a customer service rep that wears the Omnipod all the time with saline - even though they don't have diabetes - so they can relate more to their customer base.

Unreal. My only hope is that with enough complaints - funny, ala Apple with one of their botched iphone releases, who reversed a previous decision - that Dexcom will make some accommodation for those of us in this situation.

I haven't seen the CMGM acronym used before. I'm familiar with CGM for continuous glucose monitor and CGMS for continuous glucose monitor system. What is a CMGM?

With comments like that, I can understand your reaction. Thanks for taking the time to share. I had heard that many Dexcom employees do have T1 (both Reps I've met did), but obviously not so true with your experience.

I do think 'complaints' can be constructive, and have heard that Dexcom is planning FDA approval for children. But obviously not as soon as you'd like it !

You mentioned checking on your son 4 times/night. Have you heard of others w/children that use baby monitors or other methods to hear alarms at night ? It has been discussed here on TuD in the past.

Jack's Mom - I am totally sympathetic with your situation. I think that Dexcom has taken the short view of your business. Unfortunately, diabetes is a long term disease and there is definitely no cure in sight.

Someone like you will be purchasing devices like this for many years to come. Dexcom is injuring the relationship with you without respect for the 10's of thousands of dollars you will spend on devices like their CGM for many many years. Instead they have chosen to "step over dollars to pick up dimes." What do they think someone like you will do if a competitor offers a comparable quality product in the future? It makes no sense to me.

Even though your child is using their device "off-label," your doctor has ordered it for your child. Any doctor can order any medication/device for anyone. It's done all the time. Dexcom's using that to hold you at arm's length seems especially galling to me.

It seems that you have exhausted all avenues to get the Gen4 model without adding any further money. If you can scrape together the $400, I would encourage you to consider the upgrade. The additional range and accuracy only have to pay off once to make it worth it! Your child is lucky to have such a fierce advocate as a parent.

I encourage you to just put this behind you. You have more important things on which to spend your attention and energy.

I'm sorry but this is simply not correct at all.

I have been involved with biomedical tech development for years (non-diabetes), and have familiarity with the process and risks.

It is not true that Dexcom is using her off-label use to hold Jack's Mom "at arm's length" out of some kind of vicious moneygrubbing penny-wise, pound-foolish shortsightedness, and given the lengths they have already apparently gone to, it's frankly ridiculous for both you and for Jack's Mom to suggest that.

Understand this clearly: it is illegal - huge fines, jail time, approval withdrawal - against the law for Dexcom to promote, imply, advocate, encourage, or otherwise come anywhere within 100 miles of saying that children should use their product, to any patient, because they do not have FDA approval for that usage. As counterintuitive as it may seem, the fact that doctors can prescribe what they like is independent of and entirely irrelevant to that fact. The law governs companies who sell medicines and devices, not doctors.

You seem to think that's a small thing. It is not. It means that Dexcom could be crippled or shut down by fines or even ordered to cease selling products entirely. See http://bit.ly/ReECC8 for one example among many.

The best technology doesn't always win, or even survive. I've seen it many times. And Dexcom is not Apple - unless you mean Apple in 1981, up against huge players like Microsoft/Medtronic. Dexcom is a company that makes only one thing - glucose sensors - and does it better than anyone else. Want salespeople who can talk openly with you about use with your son? Use Medtronic. Yes, I think their sensor sucks relative to Dexcom's, and I wouldn't use it with my child either, but if you want a CGM that has a transmitter that can reach to the next room and has FDA approval, Medtronic's got one.

The FDA doesn't "suck." It exists to protect children like Jack, and all patients and consumers. That is hard to hear when you feel their approval for a needed medication or device is dragging, but it is the truth. Medtronic's CGM is approved for children, I suspect, because its sensor is much thicker and therefore less likely to shear or otherwise break. I guarantee you that Dexcom is not "dragging its feet" in seeking approval for children. The bar for FDA approval in children is very high - and Dexcom obviously understands how important it is, and how much of a market advantage Medtronic has because most kids will start on Medtronic CGMs for that reason. I promise you that there is either a very good technical reason that they have waited this long to seek FDA approval, or this will not be their first attempt to obtain that approval.

I understand why Jack's Mom is upset - it's easy to understand. But one has to try to think about the whole picture, as hard as that can be in a situation like this.

Thanks for the comments, and the feedback. (Sorry should not have said "complaints" but "feedback".) Yes, we use two video baby monitors at night - one to check on him, and one for Dexcom. I only get up when the alarm goes off. The main problem with the Dexcom is that you actually have to go push to turn the alarm off. So when it wakes me up, I actually have to go to his room and turn it off. I also wish that the Dexcom would show the trend graph when the alarm goes off - I could check it on the baby monitor and see if I could sleep through the alarm for a while.

I do change his basal on a regular basis, but he's so little - only 18 pounds when diagnosed, and now only 30 pounds - very small things will throw his BG off 100 points no problem. I use to treat lows with 1 carb or basically a grape and get 50 points - and getting hit with human growth hormone and the constant colds / viruses he picks up from his friends (can we keep things out of our mouth, pleeeease) makes him pretty volatile.

There are things that Dexcom can do to help parents like us which I hope will be considered going forward, but the extended range of the G4 will be a big improvement too.

I really do appreciate all the feedback from everyone - this topic and others - handling this disease in someone so little has been the biggest challenge of our lives by far. I learn something from everyone who is touched by diabetes.

Terry - thank you so much for the help and support. I only get true empathy from places like tudiabetes. Most other people can't simply understand, and I really appreciate it.

OK, to your last comment, back to potty training with a pump on your leg / butt - can we finally become pump aware like everyone talks about?!?

Medtronic - sigh - I am completely jealous of the features on the Medtronic pump. It is much better for children, I agree. However, the fact that it has no remote (nighttime and playground bolusing would become much more challenging) and we couldn't figure out how to do the wired pump thing with a diaper (my son was diagnosed as an infant), where to attach the pump (his pants are always too big because he's so skinny so anything we attach pulls his pants off - hopefully the G4 is lighter too), and his tendency to fidget just scared us off it too much. Omnipod made more sense, including the auto insertion which we all love. I have also heard bad stories about the Medtronic CGM - it hurts, the warm up time is too long, the staying time too short - that Dexcom made more sense there. For now.

Hopefully this technology - which I am very grateful for - will develop into something that works better for all of us, even the very little ones. All I can do is continue to give my feedback to these companies, and hopefully someone listens, so that at the very least this disease can get better for the families with babies after us.

You are missing the point.
What about people with NO insurance.
Who pay CASH for CGMS and for sensors ?

Again - Insurance isnt involved there. Dexcom provides the upgrade for FREE to the user and since there is no insurance - who pays ? Dexcom.

You are lucky you have insurance that covers CGMS - not everyone does.
I would bet a beer or 6 you will NOT get an EOB for the upgrade - which means that your insurance will NOT be billed for it ...

But again Im think that we have a fundamental disconnect in this discussion ...

You are welcome. You're doing a great job with your son! This incident with Dexcom will fade in your memory. You are completely right to be a strong advocate for your son; he will surely thank you for it one day.

Ask to speak with a manager and if not then their manager. Write letters. It's sad that becuase of their not communicating within the company, you're at fault and have to wait another year for something that can help control your health in a better way. After all, isn't that what their new device does? why would they deny that becuase of an error on their part?

Write a letter to the FDA to get the official date of approval for the G4. If the approval was before your order then you have the arguments you need. Because then the information that they believe it will be released in Q1/2013 was wrong.

Clever! The only issue is that the people I talked to claim that it was only known at the higher levels, that no one at their level knew until a few days before. Thoughts?

I have a new dex 4 and not using it. got in september. anyone want this cheap? Also have 3 sensores that expire 12/12 .

I meant Dex 7...the first model.

I would push and continue to push through my insurance company. Dexcom from a business perspective with out a doubt "stinks". I can assure you they new internally when the G4 would launch. The device has not been opened and they are suggesting that you replace it in a year? Even if you like their product their support sucks.