Good Afternoon, my question is does anyone else have to have their Dexcom G-6 reauthorization every 3 months by insurance, it’s really a pain, and the lack of communication is worse. My Dexcom was due to be sent on the 1st of this month was informed by my DME of the problem and i contacted my insurance and filled the reauthorization my self was told it would be done in 24 hours, well Monday i got letter saying it was denied do to my A1C being 6.2, there use guidelines say you need to be from 7 to 11 and that my 6.2 was a non diabetic #. Of course i took that well and wrote a letter to the insurance, I have contact i have been working with for years, and sent screen shots of my AGP for 1 year and a copy of my A1C lab reports for 1 year showing my A1C going from +10’s to where it is currently and asked who was the idiot (actual phrase) who decided it, I have been a type 1 and insulin dependent over 20 years. Received call from pre authorization department for pharmacy dept. and was told all decisions are reviewed and that the next day it was overruled and approved but nobody including me was informed apparently. I called my DME supplier and they didn’t know either, it was approved on 6/29 and apparently wasn’t even put into system so they are moving date to when my DME files for payment.
I know Diabeties is hard but apparently i have to handle the administration tasks also. Really frustrated, luckily i have a 7 sensor stockpile. Rant over, thank you for your time
And great job on those numbers - I guess that’s what they call a ‘backhanded compliment.’!
e
@T1john Sorry you’re apparently getting hit with this Catch ‘22 scenario. I’ve often wondered about other remarks regarding insurance companies that seem to fail to see the il-logic of their requirement for a particular range of A1c (or similar req for other coverage) to get approval when the very thing they’re approving is intended to reduce the measurement to a level below the range required for approval. It is punishment for being successful. They are, in effect, requiring people to yo-yo; to stop using the approved product of because it worked as advertised, thus pushing people back into a range that they then qualifies to obtain the service/product and starting the process over. Seems the height of stupidity and ripe for legal action. On the good side, it sounds like someone up-line recognized the range as only valid on the initial decision to provide coverage.
I can’t help but think of an insurance company saying “Yes, we’ll cover your anti-rejection drug for your heat transplant this year, but next year you’re going to have to get a new heart transplant to get coverage for another year!
While it would be a slog, if they depend on corporate users for their life, perhaps addressing the issue via their corporate purchasers is the answer?
@TomH ,I agree and My “letter” i wrote was an e-mail, and was CC to corporate. As far as there use guidelines are i imagine geared to new authorizations, not meaning a A1C of below can’t be attained by other means just that it could be cause for a closer look at request, i am not new to the Dexcom G-6, i don’t know what kind of health information they have access to but my use should have been obvious, but i truley think when they get to the first out of speck bit of information they don’t go farther, could only imagine how many the have to do. And also, don’t know what good but i also sent to Dexcom, i also have contact there, as well as omnipod that i deal with. I am a like to commend good service and all ways contact the origanzation when I receive good service, have a couple of great contacts at Apple also.
Medicare will not reimburse DME supplier without letter/form faxed from prescribing Dr every 6 months attesting you still meet their criteria. Usually Supplier follows up w Dr (via faxes). Glitches happen, need to stay on top of Dr. office & supplier.
@larry-butler Amen to that, I actually have Medicade and have fits with endo doing paperwork, his PA does all the paperwork. But have spoken with him and have a plan. Put day authorization expires in calendar with alarm set at 2 weeks and 2 days, at two weeks will e-mail him to send in paperwork and I will inform my insurance it is coming and at 2 days I will contact my DME supplier to make sure everything is on track. Have spoke with both insurance and supplier (by e-mail so I have records of their responses) about this and they are fine.