The best news of 2017 thus far: Medicare has approved coverage for Dexcom G5 CGM! After being denied up to my fourth level of appeal, I am thrilled that they finally understood how essential this technology is for our lives and well-being!
After the news, I immediately called Dexcom to order! So excited! I was told that they were “caught by surprise” by the announcement and its wording … and to give them a week to figure out how to fulfill orders. Okay then. I had waiting for 4 years. What’s another week?
A week later, I was told that it would be “some time” until they could ship but I could buy now from some of the distributors. I was referred to Liberty Medical Supplies in Florida. OK.
Well, I spent days trying to reach them, sitting on terminal hold or just calling from the wrong time zone (they are closed by 2pm in my time zone, even though their website site says they are open later).
I FINALLY reached a human being who told me that they have a “special” group handling Medicare and CGM. I was told to leave my name and number and best time for them to reach me. Well, I actually did get a call the next day, Saturday, even though they are closed on weekends.
Here’s the scoop! I have 3 choices:
- I can buy RIGHT NOW directly from Liberty at their cash price, which is actually $100 higher that Dexcom’s cash price. Not a very good option
- I can wait til March 6-15, when Medicare is expected to issue their billing codes. At that time, Liberty could take my order and bill Medicare, with no guarantee that Medicare will actually cover my CGM order. And if they don’t, I’m responsible for the full cash price. HUH? Well, that’s because Medicare hasn’t issued their criteria for coverage! So … my logical next question is WHEN will they issue their precious criteria? DON’T KNOW!
- I can wait until Medicare issues their CRITERIA to see if I actually QUALIFY for coverage. WHEN will they issue the CRITERIA? NO ANSWER!
So I still wait. I’m betting their criteria will require a medical prior authorization plus a C-peptide test (to verify that I really have Type 1 diabetes after 52 years!), plus who knows! Maybe I’ll have to dance the limbo under their lowest bar?
There you go! It’s coming. WHEN? WHO KNOWS!!!
When I called Dexcom they said they would ship to me NOW, as well as new sensors, and that they’d bill me once they had an answer from M’care. Who did you talk to at Dexcom?
Hi Gayle … I’ve been working with the head of regulatory affairs. I sent her an email tonight to get a clearer answer and will update tomorrow.
Who did you chat with? And why would they bill you? Just the 20% not covered by Medicare?
Many thanks Gayle!
I spoke with the person who answered at Customer Service Dept. I must assume she said “they’d send a bill” once billing was set up because she had no idea what insurance I have (she didn’t ask) except for M’care. I’ll call again tomorrow and let you know the latest response I get. Sadly, I’m not hopeful.
Do let me know Gayle!
Gayle, you got lucky. Did you receive your order yet? They are now refusing to fill anything for Medicare patients, unless it is G4 or Medicare Part C.
Sadly for me, I hadn’t received my order so called Dexcom. Now they say they are no longer supplying directly to clients and referred me to Liberty. Any future updates from me will be in private emails. Thanks!!!
Wow! it’s great info.thanks for share it.
Awesome blog! I’m a NP that’s new to business. I’m happy I’ve found this.