The latest instructions I’ve gotten in dealing with the insurance/CGM mess were to call my local diabetes educator, so I did, and she cleared things up for me in a big way. Apparently, beginning last year or this year, United Healthcare has a contract with Medtronic, so that’s why I’m being denied coverage for a Dexcom - they only cover Medtronic. She said I could try to fight it for now, but my husband’s company will have the option beginning next year for employees to switch to Aetna coverage, which she said should allow coverage for the Dexcom. It all makes sense now, in a frustrating way. Anyway with Aetna have input on the type of coverage they get for the Dexcom?
That’s kind of odd, since you are not using a pump. I guess I could see that if you were using a Medtronic pump they would make you use the Medtronic CGM. But if you are not on a pump, they want you to still use the Medtronic CGM? That makes no sense at all!
Join the club!
It really doesn’t, which is why I’m going to still call UHC again just to clarify that’s the case. We’ve used Aetna before, when my husband was working at a different hospital, but it was pre-diagnosis, so I’m not sure what the coverage would be like for insulin, etc.
Ha. Yet another club you don’t really want to be part of!
@Pianoplayer7008, she is not making sense. The UHC deal with Medtronic us only for pumps, and it does not apply to CGMs.
So the denial must have another reason. I am not sure how in heaven they would deny a CGM anyway…
Did you call Dexcom directly? They’re the one who profits when you are finally able to order a cgm so they’re the one who has the incentive to help you get there…
Like others have said I’m not sure the pump issue crosses over to dexcom…
Historically Medtronic cgm has been considered pretty inferior. I’m not sure how good their latest generation are in comparison
Except for those built into the Medtonics pumps such as the MiniMed 530G, which has an integrated pump / CGM system with threshold suspend (an insulin shut-off feature if BG reaches a certain threshold).
But definitely has nothing to do with the CGM only devices from Dexcom.
I would definitely demand more information - something just isn’t right with their response.
I found a thread on TuD covering this topic…seems another user has had a similar response, as well as other issues with obtaining a Dexcom CGM, as a result of this deal. Most agree it’s their way of forcing users away from anything that isn’t Medtronics.
I think the tuD thread has to do with how frequently UHC lets you order new Dexcom receivers? At least that is what I read in the section of the thread I went through.
The problem is when you try to apply logic to UHC policy and decisions…
Maybe we ought to just give people the ability to spend their healthcare dollars as they see fit and get rid of the glutenous Insurance companies profiting as the middlemen. Just a simple system that creates a blanket safety-net to rare-but costly incidents and general healthcare credits for everything in between. No claims, no haggling, just a specialized healthcare spending account that allows the people to spend their own money efficiently. I’d bet many healthcare costs would go down as a result of an infusion of competition and capitalism in the marketplace.
steps off of soapbox
I (maybe wrongly) assumed she knew what she was talking about as she is diabetic herself (said she is going to switch insurances to get the Dexcom, as she also recognizes its a superior product), and she did clarify that I’m not on a pump.
@Sam, I’m calling them next. That’s what the diabetes educator said I should probably try next, too.
Exactly. I (hopefully) just finally got another unrelated claim dealt with, and the rep I talked to said, “Um, you shouldn’t have even had to appeal this.” Don’t I know it…