I have Cigna insurance and they use an intermediary called CareCentrix to authorize me getting my Dexcom G6, Tandem pump, and associated supplies. Cigna approved the Tandem pump and I got it directly from Tandem. Under my insurance I am responsible for a 10% co-pay of durable medical equipment. When the pump was approved, Tandem called me and asked if I was okay with a co-pay of $400? This was my co-pay based on a pump price of $4000. I said “yes” and got my pump (which I love my the way). The surprise came about a month later when I got a bill from CareCentrix for $680. They claimed that the pump cost was $6,800. I called Tandem and when I told them the problem they said that they were under a non-disclosure agreement and could not say more. I told them what they had told me my co-pay would be and they said that they could not say anything more.
I subsequently called Cigna. The representative on the phone told me that Cigna and CareCentric negotiates a price for the pump that they pay, but then claim that they pay a higher cost so that they can get a higher co-pay out of me.
This sounds like fraud to me. I looked on-line and there are a bunch of case-action lawsuits in some states about this issue on non-diabetic type of stuff.
I am curious if anyone else has had this issue come up with their equipment or supplies.