For those of you on United Healthcare, I just found out that they are now covering the G4 CGM under my prescription plan. I have the UHC POS plan through my employer. As of last year, CGMs were covered under durable medical equipment with a significant out of pocket cost. Now I pay nothing!!! Not even a copay even for the new transmitter and receiver. I just wanted to share since I was not contacted by UHC about this change. I just happened to have Dexcom contact my insurance who made the discovery.
Be sure and check with your plan I have UHC as well and mine fell under DME, the same manner as a Pump would. But that's wonderful that at least some of the plans are changing! If only I had been so lucky :)
Same here - ours is DME
Heads up tho - remember not all DME providers can bill Pharmacy - i.e. prescription, you may need to change where you order your sensors. Also I cannot order more than one box at a time, a "month's" supply under prescription drug. When I was covered under DME I could order 3 months (3 boxes) at a time. My plan does have a copay tho - will depend on your particular employer contract with UHC I believe.
Thanks for the info. My insurance was just changed to UHC and I haven't had a chance to get supplies from them yet. Copays for prescriptions go as high as 35% or $200 for 3 months supply for brand names that are not on the preferred drug list. Not sure what the copays for DME are.
Does UHC make you go through a third party (like Edgepark) or can you order directly from Dexcom? (I am required to use Medco for prescription drugs btw.)
Lastly, I have working Dex 7 hardware and I am very happy with it but I might be forced to upgrade to G4 because of the need for new sensors...
I get all of my supplies from Diabetes Specialty Center and not Dexcom. That is just where UHC has always told me to go. I do wear the OmniPod and that comes from Medco. Even though you don't get supplies directly from Dexcom, I would contact them to figure out your coverage. They are great about dealing with the insurance companies and finding out exactly what you have to do and what it will cost.
When the company my husband worked for had united and my pump and CGMS supplies were all covered under the medical portion of the plan, I was able to order supplies from either the pump/CGMS company itself or go to a independent supply company (like Edgepark). I always looked for those "in network" to make sure I was getting the biggest bang for my insurance buck.
Now with this company he works for, still uses united but I now must order my CGMS through my prescription drug plan, life is a little crazy! Again I can use any "in network" for my pump supplies (i.e. directly from animus or from another provider such as Edgepark). However, many companies like Edgepark cannot bill for pharmaceutical supplies and therefore cannot cover your needs. Medco, my prescription drug provider does not stock CGMS supplies. They actually have no clue what a Dexcom CGMS sensor is! (that took 4 days of phone calls, trust me!)(to bad I didn't record them - I finally had to tell a senior pharmacist at Medco to "Google" it!) So finally Dexcom said call Diabetes Speciality Center (DSC) - problem solved. I now order all from them, they bill both the medical and pharmaceutical portion of my plan. Two seperate sections to order from, but so far no denials or problems with billing. One nice thing about having to get my Dexcom supplies thru the pharmacy, DSC tells me when I am on the phone with them and they place the order if it is approved - it's instant - so if i call in to soon, we know. Or when my Dex 7 rolled belly up and died, DSC was able to tell me that I was approved immediately when I called to upgrade to the G4.
I too have had a good experience with Diabetes Specialty Center. Very helpful customer service reps that are familiar with the needs of type 1 diabetics.