[Diabetes-Talk] Dexcom

[Eileen Scrivani]

This explanation of coverage does not make any sense to me. Its always been my understanding that when a person has Medicare as the Primary insurance and a secondary plan like United Healthcare, it is the primary, Medicare that sets the guidelines for how much is considered reasonable and if they will or will not cover the cost of a medical device.

I have been told in no uncertain terms by Dexcom that under no circumstances will they cover the Dexcom if a Medicare patient uses the phone app instead of the Dexcom receiver. In fact, I recently met with a new CDE through a local regional hospital and they spoke to the Dexcom sales rep who iterated this and went further saying that if they or Medicare find out someone is using the phone app they can come back to you and asked to be reimbursed for all the past coverages. When I first started looking into the Dexcom system and spoke with Dexcom directly they told me it is Medicare’s guidline that is creating this situation. They are still holding to this.

How/where did you find a legal advisor/attorney to take this on. These days I no longer feel my low BG’s after having diabetes 50 years and I am now alone so if I get to the point of being too low without realizing it I will be in serious trouble.

Thanks.

Eileen


From: blindhands--- via Diabetes-Talk 
Sent: Friday, April 13, 2018 3:19 PM
To: 'Diabetes Talk for the Blind' 
Cc: blindhands at aol.com 
Subject: [Diabetes-Talk] Dexcom

I did get my Dexcom finally and Medicare under United Health Care approved
and paid for it.

For those of you who have other type of insurance the problem seems to be
that these other insurances do not have a distributor under them that
contracted with them.  

I had dropped United November 1, 2017 & went to Anthem Blue Cross and on
November 3rd found out that United had contracted with a distributor gfor
the Dexcom.  I decided to sit and wait, thinking that Anthem would catch up
with this and did put the paper word into Anthem.  As of Feb. 2018 I decided
I waited long enough and had just gotten the refusal from Anthem.

Feb. 1 I changed back to United Health Care and then got moving with the
distributor to get all the information that they needed.It took about 7
weeks and I did a lot of phone calls [word of advise:  get a contact person
in your doctor's office and team up with her/him ] so if one needs info you
can touch base to keep this all moving forward.  I got it and had an
appointment with the doctor a week later only to find out the doctor's
office does not do the training for the Dexcom and they had to get in touch
with the Dexcom rep.  That was Easter week so I had another week to wait to
have the training.  I am happy to say I did my own changing of the sensor
yesterday and everything is going well.  I had forgotten my IPhone when I
went for the training session, but I installed the app.  It has warned me
for lows & even extra lows.  It has let me know of fast dropping levels.  It
has let me know of highs when the pump needle came out during the night.  

I waited 2 1/2 years for this CGM.  Waiting to hear back from appeals with
the insurance, deally with a  lawyer and preparing for testimony with the
judge to present my case why I needed the CGM.  I want to say it was worth
all of this and proved it to me that it is worth having this especially
living by yourself.  I am also happy to say, "That United Health Care and CT
Medicaid cpmpletely covered the expense."

Joyce Kane


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