The best news of 2017 thus far: Medicare has approved coverage for Dexcom G5 CGM! After being denied up to my fourth level of appeal, I am thrilled that they finally understood how essential this technology is for our lives and well-being!
After the news, I immediately called Dexcom to order! So excited! I was told that they were “caught by surprise” by the announcement and its wording … and to give them a week to figure out how to fulfill orders. Okay then. I had waiting for 4 years. What’s another week?
Well, I spent days trying to reach them, sitting on terminal hold or just calling from the wrong time zone (they are closed by 2pm in my time zone, even though their website site says they are open later).
I FINALLY reached a human being who told me that they have a “special” group handling Medicare and CGM. I was told to leave my name and number and best time for them to reach me. Well, I actually did get a call the next day, Saturday, even though they are closed on weekends.
Here’s the scoop! I have 3 choices:
- I can buy RIGHT NOW directly from Liberty at their cash price, which is actually $100 higher that Dexcom’s cash price. Not a very good option
- I can wait til March 6-15, when Medicare is expected to issue their billing codes. At that time, Liberty could take my order and bill Medicare, with no guarantee that Medicare will actually cover my CGM order. And if they don’t, I’m responsible for the full cash price. HUH? Well, that’s because Medicare hasn’t issued their criteria for coverage! So … my logical next question is WHEN will they issue their precious criteria? DON’T KNOW!
- I can wait until Medicare issues their CRITERIA to see if I actually QUALIFY for coverage. WHEN will they issue the CRITERIA? NO ANSWER!
So I still wait. I’m betting their criteria will require a medical prior authorization plus a C-peptide test (to verify that I really have Type 1 diabetes after 52 years!), plus who knows! Maybe I’ll have to dance the limbo under their lowest bar?
There you go! It’s coming. WHEN? WHO KNOWS!!!