I am not trying to stir the pot of frustration about Medicare and Dexcom … but here goes.
As I mentioned, Dexcom absolutely CANNOT sell me any product, for cash, because my file shows that I am covered by Medicare. Even if I just want to BUY a transmitter CASH, the answer is NO. They are referring everyone over to Liberty Medical Supplies in Port St. Lucie, FL, only open from 8am-5pm EST.
I finally was able to get to my desk early enough to call them today … and I sat on hold for 42 minutes. I finally reached a lovely rep named Liana (they’ve all been very pleasant).
Here’s today’s scoop:
- I first had to register as a new patient with Liberty … no problem, as, for some reason, I was already in their database?!
- Then they will request a new prescription from my endocrinologist … also no problem, even though there is one on file with Dexcom.
- Next, she emailed me the ABN (Advance Beneficiary Notice of Noncoverage) form. AHA, there’s where I learned a lot!
Medicare will cover orders as follows:
- Dexcom G5 Kit, a 90 day supply for $745.14, which may include
- 1 Transmitter
- 3 boxes of sensors
- 4 boxes of test strips, 2 meter batteries
- 1 blood glucose meter (brand unidentified), even if I don’t need one
- Dexcom G5 Receiver, for $277
After I submit this form, on which I choose whether I want them to bill Medicare, not to bill Medicare or not to order supplies, I can then call and place my order. Remember, today’s call lasted 62 minutes.
I was reminded that I would be fully responsible for $745.14 if I do not qualify under the Medicare criteria, which have not yet been published!
In other words, I will place an order, for things I do not need (because that is how Medicare is bundling it), without any assurance that I will meet the criteria for coverage and end up paying their cash price and filing another appeal with Medicare.
This amazing diabetes community has made it possible for me NOT to worry yet about being without supplies. And maybe I’m just impatient.
BUT, ordering parts I don’t need without a guarantee that it is even covered … just another major diabetes stressor!
What do you think?
But a G5 transmitter only lasts 3 months. So for all that money, if it’s supposed to be a 6 months supply ,you should be getting 2 transmitters.
Right?!?!? Well, they’ve decided to supply for only 90 days, to include ONE transmitter, 12 sensors (even if I don’t need that many), test strips, batteries and a meter (every 3 months?)! No option to simply order what I need!!!
I’ve been on a cash pay basis with Dexcom since I went on Medicare (two years ago). The Liberty price for the one transmitter and 3 boxes of sensors is less than my current ‘discounted cash price’ at Dexcom. So maybe it will be a good thing.
Anxiously awaiting the hoops that Medicare will have us jump through with documentation from us and our endocrinologists for them (Medicare) to review and ‘consider’ if they will approve CGM coverage for us.
I’ve been T1D since 1966, wearing pumps for 25+ years and CGMs for 7+ years. My endocrinologist and I had enough paperwork to go through when I went on Medicare two years ago just to prove I was a T1D. Amazing bureaucracy for sure.
Hi Nolan … I think I have you beat by one year … diagnosed in 1965!
The cash price from Dexcom for transmitters is $600 for 2 transmitters. 3 boxes of sensors is about $900. That’s $1545 for a 6 month supply. The Liberty price is $745 for ONE transmitter, 12 sensors, a meter and 4 bottles of test strips … for a 90 day supply. At 6 months, it would be $1490 … so yes, about the same. UNLESS, you get longer use out of the sensors – I get 2-3 weeks.
But you are absolutely right … it’s now a waiting game for Medicare to publish their billing codes and coverage criteria.
Keep up the good health!!!
Phoned Liberty this AM. all my paperwork has been completed for weeks. I was told that Medicare applications for g5’s will be able to start shipping on 3/15 and because I was a refered Dexcom G4 customer they were confident it would be covered.
I got you both beat. Diagnosted 1960, pumps 37years, CGM from the beginning.
Frank
Congratulations Frank … amazing how time flies!
I’m not sure all that they can be certain of the ship date, as they “think” they will have the Medicare billing codes by 3/15 but they don’t know. And since no one has the Medicare coverage criteria (or even know when that will be published), they’d be guessing to say that you’d be covered. Yes, they will ship and bill Medicare but if, for some awful criteria from Medicare, you are not covered, you’d be liable for the cost. They seriously cannot guarantee coverage.
I’m an optimist and I believe I too will be covered but who knows?! I had an administrative law judge, in my 4th level Medicare appeal for CGM, tell me that 1) I had proven medical necessity, 2) that I had shown that CGM was cost effective and 3) Medicare’s overriding principle is to act in the best interest of the patient — I was still denied!
Time will tell. I also understand that Liberty is working with Medicare about how the products are bundled. Again, we’ll see.
Update from Liberty. They Phoned me Tuesday and said Medicare had OK’d the new billing codes and they could start filling claims. They emphized that if Medicare denies the claim & any appeals I will be responsible, which is okay with me since I’m currently paying cash anyway. This morning I got a email from Liberty saying that my G5 starter kit was shipped. The UPS tracking says I’ll receive it on the 16th.
Frank
Congratulations Frank!!! And let’s hope their criteria fits us all!!!
Frank,
Good news and I’m also keeping fingers crossed. With you moving from a G4 to a G5 system you will be getting the whole kit. Did Liberty advise what the brand name of the BG meter and strips are? The generic was noted on the ABN form.
I finished up my ABN and the request for information was sent along to my new Endo this week so will have all that in place. I won’t need to order for a little while yet as I’ll be starting my last G5 transmitter in the next week or so and will have a 3-month run, but I certainly won’t wait that long to “re-stock”.
I asked the Liberty contact about the brand name of the BG meter and she said that Medicare had not yet told them what it was to be.
Thanks Nolan … I haven’t heard about the meter either. I haven’t submitted my ABN yet, as I too just started a G5 transmitter. GUess I’ll just wait until Medicare publishes their coverage criteria and specifics. And Frank, let us know what arrives in your package from Liberty!!!
I received the G5 Transmiter, receiver, & 3 box of sensors on the 16th. No meter or strips which I didn’t want. The invoice showed the items were 80% billed to Medicare and the remaining 20% was my responsibility even though I have a supplement that covers the 20%. Liberty Phoned me the next day to check I received the kit ok & to tell me my BCBS sup plan rejected the 20%, which they always do, until Med Pat B accepts the 80%. Since this is all new to Medicare I bet it’ll be slower than usual. Liberty seemed OK with that and would refill the supplement plan. At least they seem willing to work for this coverage, they should, it’s big business to be the first company to get into this Medicare market.
Interestingly the Dexcom boxes were all labeled with a description of item followed by “Medicare” my old boxes label description was followed w/”retail”
Unrelated; while I waited for Medicare I borrowed a G4 receiver, since I ruined mine by going in the water with it in my pocket. It was Dexcom who recommended Liberty when I Phoned to price a new G4 receiver. The person who loaned me the G4 receiver shipped me their whole stash of old supplies; 2 rec. 2dead Trans. & 2 bx of 4year old sensors. Curiously I tried one. It worked perfectly for 10 days!! It had an exp. Date of 2014.
Frank
Frank,
Excellent update and seemingly positive news. It appears (at the least) that Liberty is “pushing” Medicare to move along by sending them billing.
I’ll call Liberty again today to see if my Endo got her forms submitted to Liberty. They (Liberty) was reaching out to them about 1-1/2 weeks ago to get their data in place. I did my ABN as well.
Nolan,
That’s strange, I’ve been paying cash for my sensors & trans.for years direct from Dexcom, & they know I’ve been on Medicare for many years. When I had private insurance before Medicare I had to use one of there middle man vendors. But when that insurance ended with retirement they then started direct cash pay with me. In fact today I got a robo call from Dexcom saying they noticed I haven’t reordered my sensors and “I should place the order today so I won’t run out”.
Back at the end of Feb. I called to see how much $ to replace my damaged G4 receiver and was told that it was $600 cash from them, but to call Liberty and I could get the G5 starter set for a little over $1000. & they might get Medicare billing soon. That was the first I heard Medicare would cover G5.
Hi Franks … have you received your Dexcom supplies yet? Did you have to fill out a 31 day log of 4 fingerstick bg readings/day? Seems to be a new Medicare requirement.
I received my G5 starter kit about 3 weeks ago. I did NOT have to order a finger stick meter. I’ve been on Medicare several years and have been required to keep a 30 day log periodically, for my test strips,but not for CGM supplies. I don’t remember whether it was a six- month or one year requirement. The log was required to be recorded by me and sent to and saved by my diabetic doctor. But when I brought him the 30-day log the first time he said it was not necessary because every time I see him he downloads my meter which satisfies his requirement, for a test log.
So far Medicare has not refused my G5 claim nor have I received a confirmation it has been paid.
Frank
Thanks Frank … I think you are the lucky one. I’m just hoping this all smooths out for everyone. Have a great week!
Frank,
I got the same robo call and I called Dexcom back and they apologized, but it is part of their automated computer system. They fully understand that we are on Medicare. I was fortunate that when I was on commercial insurance I was able to get my supplies directly from Dexcom. Then when I went on Medicare (as you) I went to a cash pay arrangement with them. I was aware of the Medicare decision to cover CGM (assuming we meet their criteria … which we don’t yet know).
I’ve been using G5 since it was released and that is what Medicare has approved for coverage.
Due to contracts that Medicare puts out and all sorts of legal issues Dexcom is no longer able to provide us supplies even if we pay cash. This gets into a far deeper conversation than I want to get into now. I had a huge education about that with my PCP yesterday and it makes perfect sense to me, but also is frustrating … but it is government control flexing their muscles.
FYI – Medicare’s letter about the CGM approval came out in about the 3rd week of January, but we (ultimate users) never say that same letter unless we were trolling the many websites and happened to come across it.
In fact … I talked with Medicare support just a week ago and went from 1st to 2nd to 3rd level support and NONE of them had any clue about CGM and the specific letter that has been produced by Medicare and I gave them the ID number of that approval and they still could not answer any questions about CGM. Sad for sure.
FWIW – I’m getting my documents in place with Liberty Medical so that I can place my order for a new transmitter in the next 3-4 weeks along with sensors, etc..
Here is hoping that Medicare might actually have the protocol released for each of us CGM users and our respective Endocrinologist to fill out and submit to Medicare for them to “consider” if we are truly eligible for CGM use/coverage by Medicare.
There is still a hill in front of all of us on Medicare and CGM users before we truly get approved by Medicare for CGM coverage.
I’ve been working with Liberty for 3 weeks. I’m frustrated because they didn’t get the first copy of the rx when my dr. faxed it. I called on Friday and found out they needed the rx. My dr. faxed it again. I called on Monday and after an hour and a half wait I was told they needed BG logs and my doctor’s notes. Now I’m waiting.
Luckily I still have 4 more sensors which will last me 8 weeks.
Hi Linda … call Dexcom … they’ll transfer you to Liberty through a dedicated line … shorter hold time. Let me know if they still are not getting your paperwork. Good luck to all of us!
Update: 04/03/17
All my forms and forms required by Endo are on file at Liberty. Yes, they also wanted a 30-day BG log. I’ve had to send the BG log to the company that supplies my pump supplies as well every now and then. It is a Medicare requirement that they (the local supplier) have such in the files. They have told me they (Medicare) never look at it.
I didn’t have a detailed BG log for Liberty this time as I’ve been dosing from my CGM (G5) so only have about 2 BGs a day for that log. So I pulled a G5 CGM log from the Clarity data (30 days) and exported it to a CSV file, cleaned up some of the data and then saved it into a PDF file.
What is a hoot is that the G5 CGM has readings every five minutes and the report was about 9 pages long with BG readings “every five minutes”. Wonder if that will satisfy their need that we have to be testing over 4 times each day? 🙂 🙂
I also started my last transmitter this past Monday and I asked Liberty to place my order, but they indicated they didn’t want to place the order until Medicare provided their “official” requirements … which they expect to see on 04/15/17. That kind of surprised me, but I didn’t push it as it was only a week away … give or take. I’m currently ahead of the curve with 3 boxes of sensors.
RE: BG meter … Liberty said the meter was going to be the One Touch Ultra. That took me by surprise as One Touch discontinued that meter in 2012. Unless the Liberty person meant to say: One Touch Ultra-2 … which is an active meter.
I don’t care for that version of meter. I do use the One Touch Verio Flex and have found it to be quite accurate (for me anyway) and I like the more advanced test strips.
Oh well … it is a continuing saga for sure.
Medicare: Dexcom to Liberty Medical UPDATE (04/28/2017)
Well … it has been a long and trying 2+ weeks with excessive wait times at Liberty Medical and getting to the “right” person to deal with Medicare/CGM. BTW – Calling Dexcom and asking them to transfer me to a direct LM contact has not worked in the least for me.
I’ve sent electronic copies of my CGM and BG logs (at least six times each) and my doctor had sent my RX and required log notes at least three times). I had sent my ABN to LM four times. For whatever reason their “documents” acceptance/review group is a bad bottleneck.
So … I get all the documents in place (per two different LM staffers) and the last on this past Wednesday said all was OK and he would call me later in the day with shipment/tracking codes. I decided to be brave and called LM at 8:0#M Eastern (when they open their center) and I only had to wait 35-minutes to be picked up. The lady who answered looked up my file, read through it and then hesitated and asked me to please hold on.
She told me she physically went over to the Medicare/CGM person to ask about what was up with my order (that was supposed to have shipped this past Wednesday). She came back and said that they needed my BG logs … AGAIN!!!!. However, she was able to advise me that she had e-mailed a form that apparently is required by Medicare for the BG data.
They required 60-days of BG readings and it can’t be an electronic log. It HAS to be hand-written on the form they provide, scanned and e-mailed back to them. Of course one can also FAX or USPS as well. I was blown away with the hand-written request.
The form is simplistic. Has spaces for six BG readings per day. My LM contact said Medicare wanted “at least” 4 per day, but may still balk at approving CGM as that would be a ‘bare minimum’ for their approval requirements.
I’ve not kept a “manual BG” log for well over 25-years. So … I printed out a 60-day log from my BG meter and I had some gaps as some days I only did a BG test two times for the CGM calibration. So … to fill out the balance of the BG readings I pulled a report from my CGM and plucked out readings that would fill out the days I was short on with finger sticks.
I made damn sure I filled out all six spaces for BG readings for my logs that I then scanned and e-mailed back to my LM contact.
My wife commented that it would seem that one could put whatever number they wanted in each box just to have ink in the form. I told her that is a very distinct possibility.
My LM contact quickly replied and said “Perfect”. She also (about three hours later) sent me an e-mail that my order was finalized and shipped and that I should receive it this coming Tuesday – May 2, 2017.
I went ahead an ordered the complete start-up kit just to work from a baseline. I don’t use the receiver as I use my iPhone, but my current receiver is out of warranty and I figured why not get a new one. I also don’t care for the test strips or BG meter they are using as I’m using the newer version of test strips and meter (One Touch Verio Flex) than what Medicare seems to have approved. I’m going to try for a test strip RX refill in May/June so will see what kind of headache that will provide. I’m good as I have a ‘huge’ supply of test strips currently and would prefer to stay that way.
Below is what is supposed to be in my order:
1 G5 transmitter
1 G5 receiver
3 boxes of sensors
1 BG meter – One Touch Ultra-2
Test strips for One Touch Ultra-2 (I don’t know quantity)
Now … waiting for delivery early next week and will see how “refills” will work over time … about 3 months from now.
04/29/2017 UPDATE
I “think” I can now safely assume that all the paperwork has been processed and accepted … as I got an e-mail this morning (Saturday – 04/29/2017) that a UPS shipping document has been created and the tentative delivery date of my CGM products is: Wednesday – 05/03/2017.
This is a GREAT DAY to see such actually in process for those of us on CGM and now actually getting Medicare coverage for our CGM.
YES! Progress!
04/30/2017 … Head’s Up …
Just read on another blog that Liberty Medical informed Dexcom late Thursday that they were backing out of covering G5 CGM products/supplies for us Medicare patients.
I certainly didn’t hear that from my contact I had been working with at Liberty and supposedly my order is enroute to me … see my posts above.
I’ll be reaching out to Liberty and Dexcom to see what I can also hear about this.
If Liberty does back out there does not appear to be any options for us on Medicare to get G5 supplies … even by paying cash like we used to with Dexcom.
Wow, do you remember which blog you read about Liberty? I’ll give my contact a call tomorrow.
I did get my order, perfectly, a few days ago! I’m just leaving it in the box, admiring it!!!
It was TU Diabetes (http://www.tudiabetes.org/forum/t/criteria-for-medicare-coverage-of-cgm-announced/60488/37),
Long string of comments but it was near the end of them from over the past 3-4 days.
Thanks … I’m on it!
They also posted links to two other forums about comments that CMS would not cover CGM if we used our iPhones to monitor the sensor/transmitter. That gets into a whole different can of worms for sure.
That is one of the key elements as my wife monitors me all the time and that is very important for us.
Wow, this is just beginning to feel a bit heartbreaking. Thanks Nolan.
UPDATE: 05/01/2017
Just got off the phone with Liberty Medical this AM and they have confirmed that they are not going to process any “new” CGM/Medicare orders until Medicare/CMS provides solid/stable criteria to follow. Apparently it has been somewhat of a moving target.
That being said I was told my order that was set for shipment (with a UPS tracking ID) is still on track except that instead of getting 3 boxes of sensors they only shipped one box of sensors (one month supply) with the G5 transmitter, Receiver the BG meter and 100 test strips … OH, can’t forget they also included extra batteries for the BG meter. (Wow). I see all the time in the DME listings on Medicare that they are big in making sure batteries are sent for and with products.
The Liberty Medical contact could not confirm if I would be getting a recurring monthly shipment of sensors or not at this time.
So … still don’t have a solid grasp of the CGM/Medicare future for supplies.
Thanks Nolan … I sent an email to the Liberty manager I know … haven’t heard back either. Thanks for your updates! Should we say YEAH for batteries?!
UPDATE: 05/02/2017 (2nd one today)
Just got off the phone with Dexcom support and they have confirmed my comments above about Liberty advising they were not going to process any new CGM/Medicare patients/orders.
Dexcom is working very hard to find a supplier willing/able to work with providing the CGM to us on Medicare and “deal” with Medicare/CMS.
Dexcom is also looking very hard to trying to get things all set where Medicare would let them (Dexcom) handle the CGM/Medicare orders “in-house”. THAT WOULD BE BEST!!!
I’m hoping I won’t take up anymore bandwidth on this blog today.
Take up ALL the bandwidth you can toss in, Nolan! I really appreciate your input!
I received my G5 order from Liberty on March 16. I checked my current Medicare claims as of May 1 and there is no posted Liberty claim.
It could be Liberty has not filed it with Medicare, or Medicare just has not processed it yet. All my other medical claims after March 16 (pump supplies, doctor visits, insulin, test strips from 4 different suppliers) have all been filed and paid by Medicare. So it could be either a Liberty or a Medicare snafu.
I received my order last week … I”ll start watching my claims too.
I did receive my order on May 03, 2017. One transmitter, one receiver, one box of sensors, one BG meter, two boxes of test strips and (of course) two batteries for the BG meter.
No charges have yet shown up on my Medicare or supplemental billing.
I’m not expecting another shipment of sensors for the month of June (from Liberty) as there has been absolutely NO communication from Liberty Medical.
Dexcom has written and called and advised they are still trying to work things out with CMS in the hopes they can be the CGM distributor for us on Medicare.
I had a long talk with my regional supplier of insulin pump parts and they said they chose not to “jump in” up front knowing that CMS would take a long time and have many fits/starts before things started to work somewhat more smoothly. They are hopeful that they could also become the regional supplier for CGM for us on Medicare like they are for insulin pumps. They already supply CGM to non-medicare patients. My approved DME supplier is located in New Orleans and covers several states with their CMS contract for Medicare.
My regional supplier has been hearing that things may be in order by July. Who knows??
That’s all I have for now.
UPDATE: 06/16/17
Still no billing for my delivered G5 supply package from Liberty Medical at Medicare or my Supplemental coverage. As Frank noted, I’m also reluctant to use any of the items in case they decide to bill me an undisclosed amount of $$ !
I received the very good news e-mail from Dexcom yesterday and there appears to be a positive light at the end of the tunnel for getting G5 supplies.
What is very frustrating is to read the re-affirmation of CMS’ position that we will not be approved for coverage if we use our Smartphones for monitoring the G5.
My question is: How will CMS know? We all know how we advise our regional distributors when it comes to pump supplies and they ask “How many infusion sets do you have right now?” I know what I have and I know the number to advise my distributor so that everyone is “kept clean” … so to speak.
I’ve thought that maybe CMS might ask or demand that Dexcom program the G5 APP so that it knows what phone number it is installed on and that number is associated with me and I’m on Medicare and that the APP won’t work.
That is a stretch, but with today’s technology one can almost “guess” that such could be possible.
I don’t mind carrying the receiver and I’ll still be able to ‘connect’ so that my wife can also follow me. It is just the narrow-mindedness of CMS and understanding technology, capabilities and us T1Ds wanting the best care we can get for our disease.
I’ve come to call the recent mess with CMS and Liberty Medical and bottom line denying us long-time users of G5 the ability to get our products used to keep us alive … as something akin to a “Death Panel”. We’ve heard that verbiage more than once over the past number of years … but that is media drive. It is just my ‘tongue in cheek’ comment.
Now more good news. I talked with Dexcom support yesterday and updated all my endo information as they are getting prepped to supply us our products. They will properly reach out to our docs for the necessary information. That effort was an abysmal mess with Liberty Medical. The other very good news is that Dexcom is going to send me a G5 transmitter as my last one is about to shut down in a week or so.
They said to call back when I was down to one or two sensors left and they would also send along to cover me.
Again … Dexcom is simply excellent to work with.