[Diabetes-Talk] Dexcom

Sat Apr 14 03:01:58 UTC 2018

Keep on there and you will win that  battle as well. You’re a great fighter and a good inspiration for those who have those bad days and good days with the management of their diabetes situations.  

-----Original Message-----
From: Diabetes-Talk <diabetes-talk-bounces at nfbnet.org> On Behalf Of blindhands--- via Diabetes-Talk
Sent: Friday, April 13, 2018 7:07 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: blindhands at aol.com
Subject: Re: [Diabetes-Talk] Dexcom

That is where I exactly was with my after my husband died 4 years ago and being an insulin dependent diabetic for 60 years and no longer having any symptoms or signs of low blood sugars.  I was living by myself and passing out with low blood sugars and being found on the floor after being there for several hours.  I had an endocrinologist  writing letters and here on this list more then 2 years back there was a notice about money that was left for just this  to cover the lawyer's fee if you qualified and had been refused by your insurance company and medicare was part of all of this.  Well I met the qualifications  and had gone through the 2 refusals  and the state agency was doing the final appeal with the insurance company which was United Health  and that is when the lawyer took it to bring it to the first part of getting a judgement from a judge, and there was a representative from United Health and the lawyer and myself giving testomony why this appeal should be considered  At this time  the judge had asked if the lawyer would be representing me for the next appeal and had expressed to me that I have proven the need for this equipment  and I waited an additional 90 days for her decision to be delivered that she would stand by the guidelines set by medicare for not covering the CGM.  My testimony was given on January 18, 1917 which was the same day that the CMS had passed a judgement on consideration for a case by case to be considered for the need and coverage of such equipment.  It took me another year and three months to finally receive and have this piece of equipment delivered and covered totally by United Health Care and approved by Medicare.

I have also been advised by Dexcom Representatives and the Special Nurse Educators . working for Dexcom to get letters written from my Edocrinologist  to state the need for me to use  the IPhone to get this information as that is the only way a blind individual can receive this information as it is sent out by the transmitter.

So I am not done yet with this until Medicare will approve to cover the supplies for the Dexcom and a blind person using a smart phone and it's applications to tell me what my results are .

Joyce Kane

-----Original Message-----
From: Diabetes-Talk <diabetes-talk-bounces at nfbnet.org> On Behalf Of Eileen Scrivani via Diabetes-Talk
Sent: Friday, April 13, 2018 8:40 PM
To: Diabetes Talk for the Blind <diabetes-talk at nfbnet.org>
Cc: Eileen Scrivani <etscrivani at verizon.net>
Subject: Re: [Diabetes-Talk] Dexcom

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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