Why the shift to DMEs?

When I first signed up for Dexcom, I was able to have the supplies paid for directly to Dexcom. One day, I was told that they no longer had a contract with my insurance provider, and that I’d have to buy them through a DME like Edgepark, Byram, etc.

The same thing happened with my pump supplies. Used to buy directly, now forced to buy through a DME.

I’ve found the customer care at these DMEs to be largely terrible, and I much preferred dealing with the manufacturers directly.

Does anyone know why this insurance shift to DMEs happened? I can’t seem to find any info about it anywhere online. One would think adding a middle man to the process would be more expensive for the insurance companies.

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I don’t think it just happened. Over the years I have had to deal with third party supply companies on and off. I much prefer not having too, as they are too busy too disorganized and last night I found out…charging my supplies at double the price. It all depends what your HMO or insurance company or plan has decided to do. Not fun, but if you have to go this way do shop the prices. Byram has been charging way too much for my pump supplies, but they dont want too much for a box of pods. And since I wanted to try the Omnipod/Animas offer, I was surprised to see the price just about matched a box of infusion sets through them. Edgepark was higher, so I didn’t proceed with that quote. But the option was there to get one from them.

I have to use “third parties” - but they’re pharmacy, not DME for me – and I’m actually quite happy with the customer service there. DME, tends to have higher copayment amounts than pharmacy.

Yep. Like I have said elsewhere, my insurance, which has pretty good coverage is through Anthem in CA, but because I live in NC it goes by whatever BCBS of NC will cover and from where. Several years ago BCBS of NC made a deal to have Edgepark be the exclusive supplier for insulin pump and CGM supplies so there is NOWHERE else for me to go. Edgepark has been HORRIBLE for me, and I tired to find a different supplier before I found out that there were none I could use. BCBS of NC said that they did this to “provide better and more affordable care to our customers”. That’s funny because they charge about 2-3x as much for everything which means that I end up paying higher coinsurance. While it would seem like this would mean the insurance companies would have to pay more, when they make deals with DME suppliers usually the DME supplier will charge you for the full inflated amount, then only charge the insurance company a greatly reduced rate.

DME companies don’t have to care about keeping you happy because they know you need your supplies and that often you have little or no choice of where to go.

If they happen to be in network for you, I would suggest ADW diabetes. I have ordered some out of pocket from them before and they have good prices and excellent customer service in my experience.