What third party ?
If not Foundation Care, you may want to contact them. They were able to run a trial claim and know immediately if it would accept, when I had Caremark coverage for dexcom.
Fnd Care was one of the best suppliers I have worked with and sorry to leave them when I switched plans.
@Pianoplayer7008 Is your DME Byrum? Theyāve been handling UHC in Texas for a while. If so, ask to speak to a supervisor and tell them that you want a CMN faxed to your doc and any other documentation they need for a submission to UHC. A couple years ago they screwed up my submission by typing in the code for T2 instead of T1.
If they submit the right code and a CMN you will get the Dexcom. Honestly, it is pretty cut and dried.
I appreciate the offer, but I am trying to snatch breaks to look at this around my babyās haphazard schedule today - having his worst teething day so far. Though at the moment Iām obviously just sitting around on hereā¦after 2 hours straight trying to get poor baby to sleep.
Thanks for the tips. I will try to find all that documentation this afternoon and see what I can find out.
They sent me to Pumps It, which Iād never heard of.
Thanks! I originally was approved through Byram, then inexplicably, UHC came back saying I wasnāt covered afterall. Maybe they put in an incorrect code like they did for you.
I can guarantee you this is an error or process dysfunction. Cgm is considered standard of care for t1 diabetes. Even though my insurance required me to go through carecentrix, it was dexcom who sought the approval and who still ships the devices etcā¦ carecentrix just sends the bill to me for the copay. Sorry itās becoming a headache, it shouldnāt beā¦
Dexcom handled 100% of this for meā¦ faxed my doc the forms already filled out just needed his signature etc. it was totally seemless. I never had a single direct interaction with my insurance. Dexcom has people who earn their living by doing that for youā¦
Hopefully whenever the Dexcom rep contacts me, theyāll figure it out if I havenāt. This has been a months long headache; Iād like it to end now!
Sorry to hear thatā¦ it really shouldnāt be, something went wrong clearly. Just restart the process with dexcom if necessary it shouldnāt take more than a week or two to have it in hand from square one.
I know for me, the key part of getting a Dex approved was documenting blood sugars regularly dipping into the 40s or lower, since the only reason they will approve it is to prevent hypo episodes. The Dexcom rep told me that before giving me a month log to fill out with my blood sugars. I donāt know if that could be a factor hereā¦ itās also worth noting that no one ever verified my paper log, which including a number of values in that low range, in any way.
That would be problematic for me (well, at least if I was being completely honestā¦) because night before last was the first low I know about. Supposedly I had similar lows most of the time I did my trial with the Enlite, but I think those were false lows because I wasnāt on insulin.
Thatās not accurate in my experience getting two different generations separately approved years apart. The only conversation between me and the third party was how much my copay would be
Yeah, thatās kind of the problem. UHC sent me to Byram, got approved, then I got denied. Dexcom sent me to Pumps It, which was a flat out denial (going through Caremark, prescription coverage, instead of UHC). Both Byram and Pumps It employees said, āSorry, nothing else we can do.ā Neither UHC nor Caremark say theyāll cover it, each saying the other should. Pretty much been going around in circles for months.
Iām not going to say anything more specific on here on how this played out for me. Just going to say, again, itās also worth noting that no one ever verified my paper log, which including a number of values in that low range, in any way.
What if youāve never gotten any denial letters? Iāll look at our online account - maybe something on there has them set to not be physically mailed to us.
Nope.
And @cardamom, I get what youāre saying. 
Ok, I looked at the detailed coverage benefits list I can access on our account, and nowhere on there do I see that CGMs are covered through Caremark - thereās nothing specifically about CGMs at all. All it says under durable medical equipment is ādiabetic supplies are unlimited,ā with a footnote that anything over $1000 requires PA. I just called UHC to confirm, then let my doctor know. Ugh. Hopefully it works this time. I have no idea why our summary lists CGMs as covered through Caremark, and why that keeps being the line Iām told every time Iāve called before.
Caremark is the prescription drug PBM contracted by your medical insurance. In all likelihood your cgm coverage will have nothing to do with Caremark. Caremark is my prescription coverage as well and they have never had anything to do with the discussion of CGM.
Maybe a dumb question, but Iām fairly insurance naive (which of course explains part of why this has been such a difficult process!) - how do I know if thatās for our policy or not?
I am SURE you are working hard at this and working hard at being a great mom and a great wife, and a billion other things I donāt know that you do, butā¦I will say keeping a little log of what youāve tried, when, and how, would probably benefit you greatly. Mostly because I find insurance/that aspect of healthcare full of sneaky bastards who want to take insulin away from nice girls like you. I was asking how folks track their dibe stuff, and lots of folks use a notebook. So it doesnāt have to be fancy, but maybe keeping a record of whatās happened could help? Sigh. So. Not. Your. Job.
And we somewhat obsessively track the healthcare stuff at our house, and that doesnāt always help anyhow - UHC lost an appeal letter that we mailed (handed it to a mailman, it went out) and claimed they didnāt have a way to help us. And this was after (literally, we track it) 7 hours on the phone.
I hope you get it sorted out soon - it certainly sounds like a paperchase.
Just had the OmniPod trainer in our area tell me āCall the main office number and threaten to send back the pump because no one has contacted you or replied about your request for training. That usually works.ā Seriously? Howabout someone just do the job they are paid for, and set us up with a trainer (Or in your case, the medical device you need and should be approved for)? Thatād be rad!
I really should. Iām also terrible at remembering verbal conversations, so a lot is lost if I donāt write it down. I have a notebook nearby me almost all the timeā¦
So frustrating! Ha, not really related, but reminds me of something that happened yesterday - last time I saw my doc, she said theyād give me some Afrezza samples. They were out, so I called yesterday to see if theyād gotten any more. The person I talked to said yes, I drove over thereā¦nope. Still out. But the kicker was, the office manager I talked to said they hadnāt had any for about a month, since they had to throw out what they had because it was expired. 
Iām sure thereās probably some legal restraint that keeps them from giving away expired meds, but ahhhhhh, I wish someone had called me (or any of their other patients still waiting for insurance approval) and said, āhey, we have these samples about to expireā¦ā Kills me they threw it all away.
Holy cow, I would have been SO MAD. I donāt like schlepping myself around town for no reason, and if I show up and you donāt have what I needā¦fired (I actually refuse to use RiteAid in my town because a pharmacist there once told me, after I drove across town for the second time in two days, that it wasnāt her job to keep track of our prescriptions, and itās not her fault they didnāt have it filled when I showed up. Um, actually YES, that IS your job.)
I am sorry about the Afrezza. We took two boxes of expired from an office that will remain unnamed, and EH has been huffing them up and all has been well. Our NP literally gestured toward the date, looked up at the sky, and I snatched them out of her hand and shoved them into our bag. We havenāt tried to get an RX filled so I donāt know the actual cost yet.
I wish that our system didnāt dispose of expired meds either, itās insane, because that could save someoneās life. 
Fortunately I had to run an errand anyway (and my docs office is only ~10 mins away), so it wasnāt a big deal, but still frustrating. It was pretty amusing watching the office manager going around trying to figure out who gave out bad info to me, haha.
Will your insurance cover it? OOP cost is nuts ($600+ for me)!
FYI The 90-day supply of 4s and 8s that I obtained with the Mannkind voucher from my HCP retails for $797 at Wal-Mart.