Replies to This Discussion

Permalink Reply by Kristina on October 10, 2012 at 12:01pm

I have BCBS (Blue Choice). These are covered under my plan as Durable Medical Equipment. It depends on your copay. I have 20% cost after deductible. I order my sensors through Liberty Medical Supply and they cost about $1250 before insurance covers for a 3 month supply. So any type of pump, pump supplies, cgms, and sensors would be the same coverage as DME. I used to have a $1000 deductible but now mine is $500 (thank god). So I pay about $116 a month for sensors. The cost was painful for me at first but it is well worth it in the end. I have hypo-unawareness and experience a lot of low blood sugars.

Please note that I always have to fight my insurance in order to get any type of DME approved. So every time they will deny my first authorization and I have to appeal. Which is ridiculous given I have Type 1 with hypounawareness and have had low blood sugars around 20.

Permalink Reply by jm on October 13, 2012 at 5:46pm

joe,

do you use the dexcom seven plus?

Permalink Reply by Joe White on October 13, 2012 at 8:12pm

I am not diabetic, my son is. He did not want to use it because of the receiver. Not enough pocket room. He uses the Animas Ping pump (7th person to use it) and it is either just out of warranty, or about to go out. With Dexcoms G4 approval by the fda, I am figuring that the Animas Vibe will be approved fairly soon, and since the pump would be the receiver for the dexcom sensor, I am trying to figure out what the Dexcom sensors and transmitters would cost me.

Permalink Reply by MegaMinxX on October 14, 2012 at 5:07pm

G4 Sensors have been quoted to be about $350 for box of 4 and the new G4 transmitter for $600, but there may be a 'contracted' price with BCBS. G4 Transmitter warranty is 6 months, but likely to last longer.

So to estimate yearly cost, depends on how long the transmitter will last. Sensors are FDA approved for 7 days, but many folks use them for more. You might estimate for 1 transmitter every 8-12 months, and 1 sensor every 1-2 weeks, to get a ball park range.

Permalink Reply by Joe White on October 14, 2012 at 6:53pm

When I talked with Dexcom, to try and get just ball park numbers, one thing that I was told is that there are currently no insurance prices for the G4 sensors (my guess is too new) They would not tell me anything else. According to them you have to go through the enrire process to find out what it will cost you. I know that there was a contracted price for different insurance companies for the System 7 items. There may even be multiple BCBS prices based on the multiple BCBS plans, but my guess is that the contracted price for most insurance companies is pretty darn close. That is why I am look for dexcom users who have BCBS for insurance to tell me what their contracted price and what their copay or coinsurance percentage is.

Permalink Reply by DianaS on October 15, 2012 at 4:24pm

That's just it each plan has negotiated a separate contracted rate so there is no ballpark. It changes year to year and each individual plan is different. BCBS is huge they have hundreds if not thousands of different types of plans in one state alone let alone across the nation.

My insurance has also negotiated separate contracts with each individual in network DME provider so my copays varied depending on who I ultimately chose for supplies. When I first got my Dexcom I had to go through Edgepark for the first year as going through Dexcom directly was out of network. I switched when Dexcom was in network the following year and my copay for 3 boxes immediately dropped by about $60. And this year my copay for the whole Gen 4 kit is about $150 less than it was 2 1/2 years ago all because of different negotiated contracts with the various plans and suppliers. My benefits for cgms haven't changed since I started on cgms it's the negotiated rates that have differed widely.

Permalink Reply by Joe White on October 16, 2012 at 12:16pm

The BCBS plan probably negotiates one national price. The difference between the hundreds if not thousand types of plans is the copay/coinsurance/deductible as far as DME is concerned. There is also differences in pharmacy benefits, dental etc. I know with my current BCBS plan, I paya 30% coinsurance on DME, another on I have access to the coinsurance is 15%. I am probably going to be staying with the 30%, because if the Animas Vibe is approved in the US sometime between now and next year, then I know that I will reach the catastrophic limit, and for some part of the year, pay nothing. My son does not want to use a CGM until the Vibe comes out (no more room in pocket issue). I am looking for people who have BCBS plans with Dexcom as a network provider. If they give me the price they pay, and the % of coinsurance their plan has, I can convert that to what I would pay at 15 or 30%, and that way get a ball park figure that may or may not be 100% accurate, but will give me a better idea of what I would have to pay.