Where do your supplies come from?

Diabetes Technology Glucose Monitoring
1

Hi Everyone,

So Dexcom called me earlier this week and said that I was all set to get my supplies and my insurance would pay 80% after a $300 deductible. I have to admit I was really confused. My insurance covers my durable medical equipment 100%, my costs actually went down when I started using my insulin pump. Apparently, however, Dexcom is an out of network supplier. So my question is, does anyone get there sensors and other supplies from a distributor or anywhere other than Dexcom itself? I’m just looking for options to make this more affordable. Please let me know.

2

I have BCBS and Dexcom was an out-of-network provider for me originally, but I just had to submit a letter and a request (and Dexcom actually did most of hte hard stuff for me) to them to request to use Dexcom and then it was granted, such that they cover 100% now. I would recommend making a request to your insurance company, explaining why you prefer Dex and seeing whether they will grant an exception. I had no idea that such a thing was even possible, until the rep at Dex walked me through it. The process was kind of a pain, but I’m so glad now that I did it.

3

Mine come from a company called Edgepark: https://www.edgepark.com/

4

Dexcom is out of network for me as well so they set me up with Edgepark and I order through them. Their number is 800 321 0591. They are in network so I am covered at 100%.

5

I’m with Cigna and they do cover the sensors. However, Cigna uses Edgepark Medical Supplies as the distributor. It’s all kind of crazy because Edgepark then places the order with Dexcom and they (Dexcom) send the sensors to me. No wonder our healthcare system is so messed up.

6

I get mine at Edgepark Medical…http://www.edgepark.com

7

It’s pretty much “inherent” in having Health Care via multiple payers, each of whom creates (or buys) a different authorization/payment system. Edgepark provides a valuable service to both ends:

The small manufactures/suppliers, like Dexcom, don’t have to spend HUGE amounts of time learning yet ANOTHER data entry process (in order to support their ordering process); and

Big InsCos don’t waste hours and hours training those little firms, and then hours and hours processing orders with mistakes in them.

This is also the main reason why nearly every prescription, except those within the VA and Indian Health Service, are still written on little scraps of paper, prone to handwriting/reading errors. Nearly every pharmacy turns around and stores an image of the paper scrip anyway, but it’s error-prone and stupid. Why? it’s not the pharmacies, it’s the myriad of different insurance payment systems.

Our Insurance System has two main problems. The first one is the ever-decreasing payout (AKA “loss ratio”) of dollars collected in premiums to actual PROVIDERS to medical goods and services. IIRC, back around 1986, health insurance averaged a loss ratio of about 95%. Now, it’s down around 85% – that’s 3 times as much overhead, profit, advertising, obscene CEO pay, and campaign contributions.

The second problem, one which we PWDs know all too well, is cherry-picking. Can I buy a health insurance policy from anyone, at ANY price, except the special “high risk, denied by everybody after COBRA expiration” pool in my State? Of course not. (Several years ago, me and my DW left our previous jobs and became independent.) And they’re squeezing the MD’s too: more and more, the InsCos are rewarding MD’s who treat only low-cost, “successful” pts. When your Doctor has to “fire” you for being SICK, or face financial PUNISHMENT for treating you, the system needs stronger regulations.

It’s not the MD’s, or the “tort reform”, or the so-called “unnecessary medical tests” of “defensive medicine”. It’s mostly insurance greed. Recently, after a too-aggressive Mountain Bike maneuver, my MD sent me in for an MRI on my head and neck. (I was wearing a helmet, but he wanted to be sure-- especially about my Cervical Vertebrae, as I’m well over 50 years of age.) Because my pictures came back clear and I didn’t need surgery, I’m sure that many insurance lobbyists and apologists will point at the high costs of my MRI and scream, “didn’t find nuthin’, costly unnecessary test, defensive medicine, EVIL!” But that’s what a diagnostic test is all about-- when you’re not sure what you’re going to find.

OK, so they’d rather take the small risk (to ME, not to their CEO) that I end up as Natasha Richardson did-- in order to increase profits. And if I ended up dead, and my DW proceeded to sue their butts? Well, that’s where the so-called “need” for liability reform comes in!

It’s all about the profits and obscene payouts to executives. There’s another key problem, the federal gvt. being unable to negotiate on price for prescription drugs and DME, but the honest and decent solutions to the health care “crisis” are simple and straightforward. It would have consisted of two bills, less than 100 pages each. It becomes difficult only when facing the incredible political power of these institutions. Democrats are TERRIFIED of big Pharma and big Insurance becoming exclusive supporters of Republicans, with vast amounts of campaign money and spin generation. (Such as Republicans and Faux News, and ABC news, and many others quoting the so-called “independent, non-profit” Health care statistics outfit “Lewin Group”: Lewin Group is 100% owned by “Ingenix”, and Ingenix is 100% owned by United Health Care.)

Dems, of course, wanted to compromise, but but the only man in the Senate who really could have created a workable compromise has been MIA for several months, and is now RIP. Harry Reid and O’Bama staff appear to have a strategy of “add more loopholes, and MAYBE someone will vote for it.” The congressional bill, of course, is HillaryCare Version-2. (vastly complex, attempting insurance reform together WITH a sort-of, but-not-really, just-kind-of-a-backup, single payer.) This adds several reams of paper to the printed size, and the vultures have afield day picking at it.

8

Here’s a summary of how the first bill would look:

a) A Health Insurance company, operating in ANY State, MUST offer individual and family insurance policies which are equivalent (in both coverage and contract terms) to each of the policies which are offered to “group” and Corporate insurance buyers, at no more than 20% higher rates than that of the lowest-cost “group” or Corporate policy offered in that State.

b) Health Insurance Policy rates and contract terms will be available to the general public at all times, without requiring that any kind of application be submitted.

c) The only questions which may be used to set Health Insurance Policy rates insurance are (1) Age of covered person(s); and (2) Sex of covered person(s).

Not too hard, really. If they want “fair competition”, well, now they’re gonna have it-- with rules to keep it fair. Do note that even the ever-present current question “smoker or non-smoker” becomes illegal. (Nicotine addiction is a medical condition, and tons of smokers would LOVE to quit. Under these rules, InsCos would have a strong incentive to provide better programs to assist these persons.)

After adding definitions, xrefs, and (especially!!!) a requirement for actual jail time as penalties for breaking these rules (defined as felonies), it ends up at 50-100 pages. No one ever went to jail for any of UHC’s criminal behavior over the last few years-- they just settled all the cases in exchange for big piles of money. The money was, of course, from premiums which they’d kept as “profits” and “CEO compensation” – money people had paid in for health care, and which never paid for a single speck of actual care at all. Make these jailtime offenses. Get criminals such as Dr. McGuire off of the golf course at Hazeltine, into a small, federally-operated hotel room with really bad food for a couple of years, and they’ll start paying attention.

IMO, “Public Option” should have been a completely separate bill. The “Federal Govt agencies can negotiate prices on prescriptions and DME” bill would be a bit more complex, but still just a tiny fraction of H.R.3200. I strongly support H.R.3200, but I also think that the best way to eat an elephant is by taking a sequence of smaller bites. Insurance cherry-picking is the tastiest part on the whole “broken health care” elephant, and I’d start right there. Easy!

9

Ok,

First I’d like to thank everyone that actually gave me information about where their supplies come from. It was great to have the assurance that there are some suppliers out there. I got a call from CCS Medical tonight (they ship me all my Omnipod supplies) and they confirmed that they could handle my DexCom supplies at 100% coverage. Thank God I knew what my insurance was supposed to cover and had enough sense to fight back when DexCom told me I’d have to pay for them. So, they’re going to be processing my insurance approval on Monday and if that goes well (which they seem certain it will) I’ll have the DexCom 7+ on Wednesday! I’m super excited. Thanks again for your help and for those who would like to debate the merits of our health care system I’d suggest you start a new thread for that topic.

10

awesome, and I apologize.

11

I use CCS Medical for my DexCom too! So far I’ve had great customer service with them. They even overnight shipped my starter kit when my husband and I were visiting family in California for a long weekend.

It doesn’t make sense to me to go through DexCom if they’re an out-of-network supplier if I get the exact same products for a cheaper price :slight_smile:

12

I get all of my pump supplies through CCS Medical too so it’s nice for me to only have one company to deal with and it was nice that they already had all my information set up. I also like CCS Medical because they send out all the supplies necessary to use the equipment. My pump comes with Skin Prep wipes, lancets, glucose test strips, and batteries, my CGM came with IV3000 adhesive. Somehow CCS gets the insurance to cover these very disposable items as durable medical equipment. I think the only thing I’ve ended up actually paying for is my insulin and Medi-Sol that I sometimes use to remove adhesives. Thank God that going on the pump made my diabetes both more affordable and better controlled. I am blessed to have really good insurance.

13

Does Edgepark work in all states? I am having the same frustrations with Dexcom not being an in state provider, which is a 10% difference in my coverage. Also, my insurance keeps saying that the code Dexcom uses is not for durable medical equipment, another reason they won’t pay at 90%. My insurance calls it “other supplies.” When I call RegenceBlueShield, they say it is because of Dexcom’s coding, but they say it is the same code they use with all other insurances. Anyone else have a problem with this?

14

I’m with United Healthcare and Edgepark is the supplier. United covers DME at 50% so Dex is not cheap for me. But, the do call it Durable Medical Equipment. It really makes no sense to me that i place my orders through Edgeark, but the devices are shipped from Dexcom…go figure why our healthcare costs are so high.