CGM Drama

I’m just gonna copy-and-paste about these CGM shenanigans which I posted about on FB…

About a month ago I went through the process of obtaining a continuous glucose monitoring system, I device which makes controlling my diabetes far easier by reading my glucose levels 24/7 through my skin, rather than requiring me to draw blood to be read on a glucometer 6 to 8 times a day. Part of that process entailed the company that provides the device, Dexcom, to make sure that the device is covered through my insurance company (you might see where this is going). I was told it was, and paid the copay over the phone, got my device and have been really excited and happy with it for the past three weeks. I just receive “payment details” from Blue Cross Blue Shield, informing me that my medical facility will be billing me $5,511.08. I called BCBS and sure enough, the device is not covered by my insurance company. There’s nothing quite like bursting into tears while on the phone with a complete stranger. Merry Christmas to me! Apologies for the rant. I am grateful for the existence of health care in our country, and that my troubles are few, but this little “hassle” is quite a shitshow.

The medical device (Continuous Glucose Monitoring System – CGM) frustration continues. I’m posting about it with hopes that one of you may have a suggestion on how I should proceed. I paid $450 for the whole CGM starter kit (6 boxes of various things). Once I received the device and used it for 3 weeks, I was told insurance doesn’t cover it (Edgepark, the pharmaceutical device provider had cleared it with insurance, then insurance back-tracked and said “oops! Just kidding! We don’t cover it!”). Of boxes 1 through 6, I can return boxes 1 and 2. I will be charged $315 for box 3 because it was opened. Boxes 4, 5, and 6, *might* be returnable if Dexcom, the maker of the device allows it. While I understand I’ve used something that cannot be reused (from Box 3) I think it’s complete crap that I should be expected to pay $315 for using a fraction of a starter kit that I got for $450 when the denial of coverage was not my fault to begin with. Suggestions? Contact the insurance company and make them pay for it since they approved, then denied the device to begin with?

UPDATE – I just spent over an hour on the phone with BCBS. They were pretty helpful actually. It appears that Boston University cherry picked what is and isn’t covered within the BCBS plan they offer their employees. Certain pharmaceuticals are on that very long list of denied items. Edgepark will be appealing to BCBS to essentially waiver the cost of the items. If the appeal is denied, I might be billed over $2K, though the rep I spoke with doubts the appeal would be denied considering the ground of misinformation (BCBS saying they covered it and then retracting…or rather, Edgepark assuming it was covered then learning later about the cherry picking specific to BU). Fingers crossed I don’t get billed and I also get refunded what I’ve already paid.

Tonight on my way home from work it occurred to me that the box of sensors have been opened. Whether one is missing for five is missing, it’s all the same to Edgepark – it’s been opened. So, I went home and hooked back up. May as well use it while I have it if I’m not opening any new boxes, right?