FUDiabetes

Anyone else have Anthem BlueCross/BlueShield and a CGM?

I guess it’s my week to post :slight_smile: I went to the pharmacy this morning to pick up my Dexcom G6 Transmitter and was told that, as of 8/1/2021, it was no longer covered by Anthem BlueCross/BlueShield. I just got off the phone with Anthem BCBS and they told me that it was no longer covered and when I asked what the preferred one was now, she said “Contour”. I explained to her that that was a blood sugar monitor, not a CGM. I also mentioned the fact that there are very few CGMs out there and (to my knowledge) a large number of people use Dexcom. Are they expecting us to go back to the dark ages and start testing again? So now I am in the process of getting in touch with my doctor to see if they can get a pre-auth for it. Has anyone with Anthem BCBS heard of this issue?

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Seems like someone didn’t do the paperwork or made a mistake at Anthem. There really is no alternative approved in the US, and everyone I know who is using insulin is using one. I would expect your doctor will get this sorted in short order.

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Back in January when I was in the process of getting a G6 it was supposed to be through Walgreens, but then that got changed to a diabetic supply distributor, Solara.

I’m afraid you are going to have to waste a lot of time on the phone with Anthem to begin with to find out how CGM prescriptions are being handled. I’m not sure how it works as I have Aetna. Evidently Solara charges Aetna.

When you find out the changes, you will probably have to work with your doctor’s office to get the prescription to the new distributor.

Good luck, I am back to fingersticks because of a transmitter fail at 2 weeks, Dexcom is supposed to be expediting one now.

My conspiracy theory is they makes stuff more complicates so we just give up. My wife is one who has no patience with this. She marvels at how determined I am to get things right.

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I agree this may be the case. My insurance only did as DME at first, but now allows as pharmacy or DME. My Pharmacy benefits limits to 30 day supply per order, and DME did 90 day. Net cost is lower for pharmacy for me and more reliable.

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It may be that your plan stopped pharmacy coverage, but will do as DME. Try to get better answers from BCBS, or if is employer plan, check if employer initiated change (HR/Benefits).

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It’s not a conspiracy- it’s the selfish insurance carrier. Well, maybe it is a conspiracy.
I have also bounced from DME to pharmacy and back over just the past couple of years. Welcome to the U.S. health care system.

My biggest fear is, what happens when I have to go to Medicare next year? No one at the supplemental plans can tell me if my G6 and Omnipod will be covered.

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@SteveMann As of about a month ago Medicare was still covering G6 and Omnipod. G6 is by DME, but Omnipod has to be by pharmacy. I have heard nothing about them stopping.

However I think some people pay varying amounts. In my case I have a supplemental kick in and my Dexcom is completely covered by DME but I have to pay $40 for a 3 month supply of my pods because it’s pharmacy. No biggy there. But if you go for an advantage plan be careful because different companies cover different things and in different amounts.

However now I am curious, I think I still will have the same coverage, My supplemental plan is through an ex employer and the parameters I believe are controlled by them, but it is managed by BCBS. Our supplemental coverage is listed by BCBS that they cover copays etc for whatever medicare covers. So I expect it will stay the same as I don’t think they can change that parameter. But…??

Dexcom is or will have a fit. BCBS is a huge insurer. Someone needs to let Dexcom know asap that’s been turned down. They will already either have more information on it or will start working on it.

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I’ve had problems like this before with Blue Cross/Blue shaft (I mean Shield). I was able to get it resolved by telling them that I was more than willing to drag the BCBS bane thru the mud in the news and social media. As soon as I told them that, I was transferred to a manager that was more willing to work with me. At the end of the conversation they did ask if I would be willing to sign an NDA about the conversion to which I told the guy to “GET BENT!” They did honor the agreement though.

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I think MM2 is probably right. I have BCBS and for me it’s not a pharmacy benefit. It’s durable medical equipment which in my case I order through Edgepark. If I tried to get it at the pharmacy, they would tell me it wasn’t covered.

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Does this program have a name? My wife is currently insured through BCBS where she works, and it would be wonderful to keep the same coverages as she transitions into Medicare.

@SteveMann It’s completely from/through the employer, not an open market plan. Check with your company and see if they have that option available. The larger companies are more likely to have a conversion supplemental plan.