Dexcom Using DME

Just wow…Talk about a shock. I have UMR insurance and I must get my diabetic supplies specifically my Dexcom G-6 Sensor and Transmitter… through either Bryam or Edgepark Diabetic Supplies.
Please tell me how it is legal to charge a consumer a price of 900.00 for a 3 pack of sensors and a whopping 817.00 for a transmitter. Whereas I can use a program like Good RX or Single Care, which I might add does not cost me one red cent to use, pay just 165.35 for a G6 Transmitter or 112.89 for a single sensor.
Oh yeah I have a high deductible, then after that’s met, my insurance company only pays 70%. Basically after I reach the high deductible, I would still be paying more per item than with using my insurance than using Sams Club or Cosco or even Good RX.
Can somebody explain this to me ??
I want to write a letter to UMR explaining how un-just this is…but I do not know how to go about doing this…to bring my argument to draw attention for cost-saving medical supplies for us diabetics.
I’m sorry I just had to vent…I’m sure someone out the FUDiabtetes community can help me to write a letter.
Thank you…
Maggie
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Hi Maggie.
One thing that can help is to look at it as a yearly cost instead, and compare it that way.

For example, suppose you started in January, and you got the supplies every few months for the entire year. At what point is your deductible met, and after your deductible is met and you are only paying 30%, how much is your total yearly out-of-pocket cost for a year’s supply of Dexcom through insurance?

Then do the comparison the other way. Add up your cost for an entire year if you do not use insurance at all.

Also, if you are using a pump, that would help you hit your deductible sooner if it goes through DME.

There are ways of re-using sensors too, which can save money. And also extending the battery life with different apps. @docslotnick can help with some of that.

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I have done this the past few years, and with cgm, pump and insulin, it has always come out net lower with using insurance. I always meet deductible within 6-7 months. Last year my 3 day hospital stay by itself maxed me out, so essentially all other cgm, pump, meds were 100% covered. Depends on how you look at it. Always using insurance means I know upfront what max will be.

This year I learned my dexcom can be purchased via pharmacy, and will switch to that for next order, so even better, with cost similar to cash/coupon cost and will apply to insurance.

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Maggie, I had a similar problem in 2018. My insurer was insisting that my only option for buying Dexcom supplies was Edgepark. Luckily (for me) Edgepark and my insurer seriously botched a prior auth renewal in late 2018. After it dragged on for about a month I documented everything in an email…faxes that were supposedly sent but never received, hour-long phone calls, etc. At the end of the email, I added:

"For 2019, I believe that Edgepark’s demonstrated inability to handle prior auth for a DME refill on a timely basis obligates (insurer) to allow me to re-order Dexcom G5 supplies from a different supplier. I also have concerns about how the co-pay is applied to a grossly inflated price from Edgepark. The ideal scenario would be to allow me to re-order directly from Dexcom, whose retail prices are less than half of Edgepark’s inflated prices. This would save both me and (insurer) money and grief.

Thank you in advance for any help you can provide with this DME re-supply and for 2019 options to re-order Dexcom G5 supplies. I’ll be glad to discuss this if you need further info, feel free to call"

After that email, the insurance company pharmacy services department called and got me all set up to buy Dexcom supplies from my pharmacy, saving me a boatload of money and grief.

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Was this actual delivery/insurance amount or a quoted price?
$900 for sensors could be 3 month supply (3 boxes, 9 sensors), and $817 could be 2 transmitters (high, but more reasonable). This is approximately same as my DME charged, but reduced a bit by insurance EOB.

I had a similar situation with Cigna and Carecentrix and was quoted 1688 for my 1st 90 day set of 9 sensors and 1 transmitter… the dexcomg6 sensors are technically 10 day sensors, so they are hopefully giving you 9 sensors to match the 3 month transmitter. You can try to write a letter, but unless you are looping with a pump, the libre (usually around $816 per year or less), and the miaomiao2 ( $200 after shipping and flexfit tape) is the best way to save money…especially since you would not have to do the Dexcom restart sensors in the microwave hokey pokey… you put the test strip in, you take the transmitter out, you put the transmitter in the microwave as you call your work and tell them you’ll be an hour late again, then you turn yourself around…no thanks… plus the Dexcom g7 will be exactly like the libre miaomiao2 combo, only 10 times more expensive

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When I had a high deductible insurance plan, it was HSA-compliant, so for some things I just used Good RX and paid out of pocket with my HSA. The Good RX savings plus the HSA savings ended up being cheaper than buying through the insurance. (It was for some prescriptions in this case, not for Dexcom supplies.)

It sure was a pain though.

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Because your insurance negotiated a contractual price with them that is nowhere near their list price— which is what you’re stuck with until the deductible is met. It’s a terrible system we have.

Sam,
Is there a way to do a letter writing campaign to ask the insurance company ( UMR ) to help me pay for the Dexcom thru a Medical Supply company?

Dexcom is getting more pharmacy plans to cover, and usually ends up as lower cost. This year my plan covers dexcom either way, and I just switched to pharmacy.
Check here
https://provider.dexcom.com/pharmacy-coverage

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I have Tricare insurance so I also have to use a DME distributor, Solara Medical. They charge $1900 for a box of 3 sensors (no this is not a typo). Despite the fact that my out of pocket limit for the year is $3000, and I pay 20% once my deductible is met, I objected to them charging so much and my 20% being so high for just a one month supply. So I got a new prescription and purchased 3 sensors from Costco for $318.64 and submitted a claim to Tricare. I included a letter explaining how the US taxpayer is being ripped off by theses outrageous prices (Tricare is for active duty/retired military and is taxpayer funded).
I am still waiting to see if I get reimbursed.

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Is that amount submitted to Tricare? I would expect Tricare to knock it down to closer to Costco cost. Thats how commercial insurance works, the billed price is irrelevant.

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the last order I made was for a 90 day supply. Solara billed Tricare $6750.00 and Tricare paid out $5737.00, 85% of the total amount billed. That is significantly more than the same order would have cost at Costco which would have been just under $1000.00. If Tricare paid out 85% to Costco, that would have been less than $850.00, a far cry from the amount paid to Solara for the exact same order. And this is all at the taxpayer’s expense.

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Most commercial plans limit the cost to be much lower, regardless of supplier. Solara is getting a good deal from Tricare.

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Depending on your employer and how they agreed to coverage, I also have UMR and am covered through my pharmacy benefit. Have you looked in to that?

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I just called the HR dept. representative who works with the HMO at work and told them about this a few yrs ago and asked for them to contract with other companies. I fired Edgepark Medical. The HMO added other suppliers.

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