Oh, insurance… What are you doing?

10 11 2009

I got a letter yesterday from my health insurance stating that they are no longer covering my Dexcom sensors, starting from August. I was confused because they’ve covered them in the past. Based on the code they listed, I assumed I had hit my DME cap for the year (this was my first full year on the sensors) and would need to appeal.

However, after spending 1 hour talking to 5 reps, I found out that the health insurance has randomly decided they are “disposable” since I throw them out after 7 days and they don’t cover “disposables”.  I imagine that “disposables” is intended to cover things like alcohol wipes and cotton balls, which they should rightly not cover.  However, 7 days is hardly “disposable”.

Edgepark (the company that provides the sensors) is already working it and their argument is that they’re not considered “disposable” since they are used in conjunction with a Durable Medical Equipment (the receiver).

I won’t know anything for at least 5 business days, but it is good to know that Edgepark is trying to regain my coverage.  I really cannot afford to either a) pay full price for the sensors or b) limit my use of them to every other week or similar.  I just hope this gets straightened out.





Cutting it awfully close

29 09 2008

I had a system set up for reordering my sensors.  When I put in a new sensor and I only had one spare for backup, that’s when I would call EdgePark to reorder.  That way, I would still have a backup and new ones would arrive before I had to tap in to my last sensor.

Things do not always go as planned.

I called to order and then didn’t hear anything for a couple days.  The nice CSR told me that they were waiting on a Rx from my endo.  Um, what?!?!?  Turns out that Dexcom “changed their packaging” or something and they needed an updated letter of medical necessity.  I instantly paled at the thought that my sensors would no longer be covered and I’d have to jump through a million hoops to get them back.

It took an awfully long time to contact my endo (they don’t have a number that goes straight to a person, only a line where you can leave a message) to know if they faxed the form.  Then an awfully long time to get confirmation from EdgePark that they were sending my sensor.  They were able to ship one box, then it looks like I will get a 90 day supply after that.

I stretched my penultimate sensor as long as it would go, but I eventually had to switch to my very last one.  I have been extra careful with it to make sure it lasts until my new sensors arrive.  I finally got the tracking information today and the new sensors arrive tomorrow.  Today was day 7 with my last sensor, so they are cutting it awfully close…