Today I’ll receive my 3rd free sensor from Dexcom because they can’t seem to submit an authorization request to my insurance company.
I’m just very confused by the whole situation. They appear totally willing to give me sensors (after the whole run-around resulted in a conversation with a supervisor), but they can’t seem to just send the authorization request so that I can actually put in the full order.
I think they’re on a 10 day back-order, so even once my insurance company finally gets the request so that they can actually approve the order, I’ll still have to wait 10 days. I have a little stash (but I’d like to keep it that way!) so it’s not an emergency. I just don’t understand why shipping me sensors overnight (in these little 1 sensor/box increments) is easier than faxing/emailing/calling in an auth request.
The whole situation is very strange.
Beurocracy? Broken healthcare system?
Lots going on behind the scenes stopping them for whatever reason…
I think bureaucracy is a small part of it, but I place this squarely on Dexcom and who they are hiring to do this work. Tandem is a dream to use, and getting their supplies is effortless, including the insurance pre-quals. Dexcom has had a problem for a while, enough that I have a senior employees contact info because their lower level employees screwed our order up so many times in a row. And this was before they laid everyone off.
I get all my dexcom and pump inf sets through Byram. On line reorder, they contact dr as needed for rx, etc. I get reminder email, log into site, order. They have a nearby distribution center and get my stuff in 3-5 days.
I got self pay G6 from costco, and did call dexcom when first sensor failed. Got replacement and tape within 3 days, after call to support that lasted about 10 min, including wait time.
I don’t understand what drives the choice of direct order to dexcom vs dme supplier, that seems to lead many to direct dexcom sales, long wait times and frustrations.
In my 10+ years, I think I contacted dexcom 4-5 times.
My insurance company contracts with CareCentrix, and I must get my supplies approved through them. I don’t think it’s an option to contract with a supplier through them. I assume that it would cost more (to the insurance company) to add another middle man. I’ve never actually asked if I could add a middleman though. Maybe I’ll ask next time I talk to CareCentrix.
In the past I worked with a distributor in Utah that handled my Medtronic pump supplies. I had many frustrating conversations with them, so I’ve never thought a distributor would be a better scenario.
Costing more to insurance company to bill it, means higher costs for employer
I guess it depends on the distributor (and maybe some percentage of luck.) I’ve been getting my supplies via Byram because Dexcom told me they are the ones who can deal with my insurance, and it’s been easy. I just place the order and they do whatever it takes to make it happen. Every time.
Yes, That is how employer sponsored health insurance works in most instances.
I’m so frustrated right now, too… Both my sensor and transmitter failed today (sensor was in under 24 hours). Transmitter had a few weeks left on it. Spoke with Dexcom tech service; they ran diagnostics (Dexcom readings were consistently 100 points above/below my finger sticks – this has never happened before – or maybe it has and I haven’t tested; I was just tipped off when my alarm was screaming LOW at me and I didn’t feel it at all; fingersticked in at 147 so then kept doing comparisons through the day). Dexcom says they’ll send replacements for both but b/c they’re back ordered they can’t ship for 5-7 days – WHAT? I don’t have an extra transmitter at home (and I’m on vacation in Florida). So I’m going to try to have my dr send a prescription to Costco in MA and see if I can do the Costco thing when I get back home b/c trying to go through my mail order pharmacy will take an equally long time. I am SO TIRED OF BEING DIABETIC. And I have come to realize exactly how much I don’t miss taking finger sticks. Ugh. Jessica
I’m sorry. I feel this more too when dealing with crap like this.
If things don’t change around Dexcom soon then I’m going to switch to the Freestyle Libre. I like the Dexcom a lot, but I’m not sure it’s worth the headache anymore.
In our experience working with Byram healthcare was frustrating enough that we did not use the CGM for years because of it. It was an unmitigated disaster. Once we could finally get away from Byram, it was worth using the CGM again. Clearly, YMMV. I am sorry that you have been struggling with Dexcom lately, it is very strange that they would not get it taken care of.
I get that completely. I’m in the process of trying to figure out if I can order through pharmacy, because ordering through Dexcom directly, which I’ve always done, is so awful and such a timesuck that if the Libre had all the functionality of Dexcom, I’d consider switching myself.
Just try it. Easier than asking.
I don’t think Dexcom is unique in this inability to process insurance pre authorizations. My cynical suspicion is the insurers all got the memo and dreamed up a new added layer of over complication that has thrown another monkey wrench into the gears. My solution, (which worked OK some of the time but not all of the time) was ordering Dexcom supplies at the pharmacy, which required that the insurer give the pharmacy an override code (“special permission”).
I had a similar snafu with Edgepark back in December…except for the free sensor part! After a month of delays, missing faxes, etc. I ended up determining that the problem was at my insurer, who was not able to properly manage their vendor (Edgepark). Example: Edgepark was using the “wrong fax number” for about two weeks and whoever at the insurer end who picked up the fax never informed them…that turned out to be my job! Naturally, when the pre authorization was finally approved, my insurer faxed it to Edgepark who never received it (wrong fax number again). I gave up on dealing with it and got my insurer to approve an override to order at pharmacy with fingers crossed. It took many phone calls to the insurance company to get the override approved. And the pharmacy benefits people at the insurer called my pharmacy and walked them through the order/override process.
I’ve learned that the problem lies in certain insurance companies now requiring an authorization to occur every 30 days. This threw a wrench in Dexcom’s already burdened system.
My insurance doesn’t require the 30 day authorization, but because they contract with Carecentrix, they’ve been grouped in with all of those that do.
I’ve learned a great deal in the last 30 days about “A codes” (need this for 90 day authorization) and “K codes” (30 days authorization).
I’ve learned that nobody ever knows what they’re talking about, and then occasionally you stumble upon a hidden gem who tells you what the problem really is, you solve once piece of the puzzle, and then you move onto the next one (and talk to many people again until you find another hidden gem). Unfortunately, I often can’t get ahold of the hidden gems ever again. Even the senior employee at Dexcom who gave me their phone number doesn’t seem to answer their phone.
It seems that the blame lies entirely upon my sales reorder specialist at Dexcom who sent a request to my doctor’s office using a K-code rather than an A-code. The K code on my letter of medical necessity prevents me from ordering a 90 day supply. My reorder specialist seems to be the root of the problem every time. If my benefits weren’t so good, I’d consider switching insurance companies just so I can get a different reorder specialist. My reorder specialist at Kaiser was always a dream.
Anyway, rant over. Maybe this will help someone else who is struggling with an order?
The solution, it appears, is to have Dexcom ship the order every 30 days (grrrr…). However, I can get the sensors authorized for the entire calendar year. Dexcom will ship them every 30 days without a need for any additional authorization. Which is actually really awesome. I can extend the life of my sensors enough that I’ll always have at 90 day supply (likely more!), but I’ll be getting the shipments in shorter increments. Only 1 sensor authorization per calendar year required!
The transmitter authorizations still need to occur every 6 months, but I’m totally okay with that.
I’m dancing around a bit over here
I’m so glad! Because that was quite the battle. Thanks for sharing about it however! It’s always so opaque and confusing but you’ve managed to shed some light on the process.
i have had this same experience with Medtronic for all of my pump supplies. i use CCS Medical through my Medicare insurance, and within all of the 18 years that i have used them, i have never had one glitch. i dont want to jinx myself, but they are very reliable, their customer service is outstanding, and the wait time to speak with a live rep is minimal.
i like the company so much, i entrusted them to deal with my Dexcom products. CCS is awesome, but in the past 1.5 years, Dexcom has deteriorated. their once stellar customer service is now horrid. i think that this all started when the G6 model was coming out.
PS: just wanted to add that Medtronic has slipped with their customer service in the past year as well. they used to replace infusion sets and send them overnight asap if there were any problems. not so anymore. now they put you through a whole rigamerole for replacements. and, whats worse, is that they are even backordered on many products.
BUT: i must add that their supply delivery is always on time and complete. never a product missing. (which confuses me as to why they would have trouble with what they call “back orders.”
I’ll share one more “funny” thing that happened in this whole #$%^show – when I finally received the Dexcom replacement order (was supposed to be one sensor and one transmitter), it was two sensors! Ten days later! I called, they acknowledged somehow sending the wrong stuff, and actually then overnighted a transmitter. In the meantime I had gone the Costco route and slipped under the deadline of them changing the program (i.e., raising prices) so had a transmitter and was back in the CGM game already, but wow what a runaround! Ugh. Jessica