Yeah I call Dexcom directly for orders and they come directly from them but the approval and billing and copay ma etc all had to be setup through carecentrix (I think) which I’m assuming is my equivalent of her bryam
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Yeah, not sure if I’ll end up having to go through Byram or not. That seems a DME thing, and apparently that’s not the coverage im supposed to go through for this. Who knows who I’m supposed to be dealing with - that’s the issue!
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Same here: UHC won’t let us deal directly with Dexcom unless we are willing to be out of network (that’s 20% more expensive then). We have to deal with Byram.
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Half the time they just get people so confused that they give up. I’m really looking forward to that sort of crap when I’m nice and old… I’d start with Dexcom and see where the trail leads you
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I second the teamwork aspect of healthcare (I wonder how your husband as a nurse feels about that actually! Maybe I’m crazy, but I thought your husband was a nurse?).
Anyhow, I’m sorry. The healthcare yoyo sucks, whomever’s fault that is, and I wish we all were not on it.
You’ve got this! Take a break from the fight now if you need to, but the Dexcom is something that can be so helpful and is medically indicated.
Also, I would suggest recording details about your fights with healthcare – either in a document while you are on the phone typing, or if you’re using the chat channel of your health insurance, copy and paste that into a document afterward. While it’s not helped in my most recent issues, it does make for a stronger case I think.
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Dexcom is the one that explained to me though that I need to call carecentrix and figure out my copay and coverage and stuff, I’d never even heard of them until Dexcom pointed me toward them… so Dexcom sends them the bill then one of the two (I don’t remember which) sends me the copay bill
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Give me 2 minutes to straighten out the post order 
reopen in a jiffy
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Thanks; I’ll call them tomorrow and see what they say. I understand those who get frustrated and give up! I’m not giving up, though. 
@TravelingOn, he’s very frustrated, too (and yes, he’s a nurse!). He’s seen firsthand how insurance denials affect his patients, so it’s hard for him to have us be dealing with the same issues. Thank you for the advice about recording things - I always intend to do so, but I forget!
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I would second Sam’s question. What is your actual current diagnosis? I believe you have stated you have UHC - correct? UHC has very specific guidelines which require a T1 diagnosis. Very specifically, NOT for gestational diabetes. I am no insurance expert but I would think it is the most current diagnosis that counts?
“Long-term continuous glucose monitoring for personal use at home is proven and medically necessary for patients with type 1 diabetes who have demonstrated adherence to a physician ordered diabetic treatment plan.”
@TravelingOn - In terms of Byram - sorry you had a problem with them. For us, Byram has been no issue to deal with for our Dexcom orders. Up until the start of 2017 we always dealt directly with Dexcom which was ideal. Starting with 2017 we had to go through a distributor.
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reopened, sorry, split thread was messy
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Hmmm, I wonder if being diagnosed with LADA is causing issues, too. It does seem like it’s just some confusion over who’s supposed to cover and at what level, but maybe the diagnosis is part of it, too.
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I never did until the recent grizzly battle over an EEG that I got in February that UHC denied because my GP’s office (he has moved away in June) didn’t file the piece of paperwork required to have the visit covered as an in-network visit. So I’m paying for that one, but it took approximately three written letters and 14 hours on the phone with UHC to realize that. Now I write it all down.
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You ARE uhc - yes?
Assuming so, the UHC guidelines (for cgm) specifically state “type 1 diabetes”. Is “LADA” an official diagnosis or just something else? (I really have no idea - no insinuation.) Does LADA = “type 1 diabetes” or would UHC potentially see these as two different things? Not trying to be a smartA$$ but are you positive you are diagnosed with LADA or is it possible the most recent diagnosis is gestational diabetes and so could that be coming up as the current diagnosis? UHC very specifically says cgm is not appropriate for gestational diabetes (my para-phrase of their policy).
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Yes, UHC. LADA is just type 1 in adults (old terminology if I remember correctly) - latent autoimmune diabetes in adults. That’s what was put in my chart by my doctor when I was first diagnosed. I’m not sure if she’s put anything different since; I’ll have to check. I’ll also have to see if UHC recognizes that as Type 1; that’s a good point. I did get a “pre-diabetic type 2” diagnosis from a (horrid) endo a few months ago, but as he’s not the prescribing doctor, that shouldn’t matter, right?
If that doctor submitted the office visit as an insurance claim then UHC would have that information.
UHC does not consider cgm to be medically necessary for Type 2 nor gestational. So yeah - that could be a big deal.
Per UHC:
“Long-term continuous glucose monitoring for personal use at home is unproven and not medically necessary for patients with type 2 diabetes or gestational diabetes.”
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I’m not a doctor or anything, but I suspect all they care about is the IDC code (or whatever) that was used in the billing that they processed— not the docs own reference notes
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So I guess I need to find out from UHC what exactly this is being billed as? A CGM under a Type 1 diagnosis versus Type 2?
I don’t know how it all works. Every time you’ve seen your doctor they’ve billed your insurance for one or more codes of what they’re treating you for. Doctors treat so many diabetics nowadays that I think they often just automatically go “diabetic consult that’s a code 199” or whatever it is… to get all the cool gadgetry you need to be sure they’re using the specific codes that are applicable to type 1, not just the codes they use all day every day… again I don’t know the finer points of all of this but this is as I’ve gathered
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UHC considers LADA to be different than Type 1. They call LADA an “other subtype of diabetes”. They go on to say it is a variation of type 1 but they have it listed as a different category than Type 1.
So if the UHC cgm policy is specific for type 1 - potentially they might not see LADA as fitting ?
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