Wednesday, December 5, 2012

Dexcom G4 and the G-mess

Grace has worn the Dexcom SevenPlus since late September. Completely paid for by her insurance. Sensors and all. They approved it not through her DME (Durable Medical Equipment) benefit, but through her prescription benefit. I really don't care if the approval comes through her vision or dental benefit, hey, she got approved! We were thrilled.

All was well, and even better, when Dexcom alerted us that since we received our SevenPlus in late September, we would be eligible for the free upgrade to the Dexcom G4, that sweet piece of technology that everyone is raving about. Oh, the range! Oh, the colored screen! Oh, the alerts! I finally actually lucked out and had some luck in the diabetes game - a free upgrade to the latest and greatest. Yes, sign us up.

I looked forward to the arrival of G4 around the end of November.

And sure enough, Dexcom delivered a pretty pink Dexcom G4 to our doorstep a week ago. What a beauty. We were so very excited. All I needed to do was call our supplier and order the new sensors, right?! Right.

I called. Hmmmm they said, we tried to process the G4 sensors, and they are denied under her DME benefit. We will try the prescription benefit. Hmmm, not approved through that either.

Called our Dexcom rep, who has been nothing short of remarkable and patient and knowledgable. No, she says, they ARE approved, I know it. She tries to call. Nope. Not approved. And processing now through DME. What the what???!!!

OK, we will just fill out a Certificate of Medical Necessity and write a short note, and get the endo to sign it, right?! Right. We are going in for our three month endo appointment anyway, so why not. Our endo signs off on the CMN, and the short summary, to our health insurance company.

I got a call two days ago from our endo, who gives me an update. And it will shock you, same as it shocked me. The secretary at our endo's office actually starts to laugh as she tells me. Not cause it's that kind of funny, it's more like incompetent funny than anything else.

Grace's health insurance is denying her the G4 sensors, because they have no record of her having a Dexcom CGM at all. Nothing. Not one receipt. Not one payment. They have no idea what we are talking about, because, according to them, they have paid for NOTHING. She does not have a CGM.

I call them and talk to the person who called our endo's office. I start to chuckle and say, you know, Grace is right now, wearing the CGM that YOU paid for. She has a receiver, transmitter and sensors, two 8-pack shipments so far of sensors. Silence on the end of the line. I tell them, I assure you, the insurance company you work for paid for them, in full.

They have no record of payment for her CGM. They have not one receipt they are telling me.
And we still have no G4 sensors.
But we do have one pretty pink receiver sitting on our dining room table.
I think the ball is in my court.
Game on, health insurance company.


Joanne said...

Bizarre... Some days I hang up with the insurance company and I have more questions than I did before I called. Ditto for the company we get Elise's supplies from. It's a constant battle, isn't it?

Good luck, I hope that one of these days you just open your door and find a box of sensors sitting there. That's how I found out we'd been approved for the G4. Poof, it just appeared on my doorstep. Even though I had called a few days prior and they still didn't know when they could get the system out to us.

You gotta laugh, right?

Scott E said...

That's why it's so important to save your Explanations of Benefits. My philosophy is that anything that the insurance company prints can - and will - be used against them... if you can find it. I hope you can resolve this before Grace runs out of sensors!

Jennifer said...

Duh. Just duh.

Unknown said...

Hmmmm...sounds like someone on the insurance end has some explaining to do!

Many, many years ago we tried the Navigator. I think it was 2008-ish. Our insurance company approved the system...but refused to refill the sensors. Flat our REFUSED! We had a shiny Navigator and the 4 sensors that came with it, but we couldn't get another order. Thanks for the expensive technology that won't work without the sensors! Appreciate it!

Shana said...

How completely frustrating. It makes me sick that you have the G4 and can't use it. It's so much better than the Seven!! I have some sensors. How about if I send you some? When you get yours you could repay me.

Doesn't make sense for you to not be getting the benefit of the G4 now.

DM me on twitter. shanadfisher

Denise aka Mom of Bean said...

shaking my head and in total disbelief!
what kinda of crazy pills are they taking?!?!

hope you find success soon!!!

Sara said...

I had a VERY VERY similar experience with my insurance company - only with my last 7+ order. They paid for sensors for 2 years only to deny my final order and ask that they go through my prescription coverage. The only problem was that they were not part of my prescription coverage. And around and around I go. I'm still trying to work my way through insurance for the G4.

I think that THEY think that we will give up if they make it difficult enough. Clearly they haven't met us!

Karen said...

Okay, that is just freaking bat crap crazy!!!

Anonymous said...

Give us a call at 1-800-423-0896, we deal with insurance companies to help you get your sensors.