Medicare and CGM "restrictions"


(Bill) #1

I was perusing the Dexcom site after reviewing another thread. As I drilled deeper into the site I came across this information:

Attention Medicare patients: Centers for Medicare & Medicaid Services (CMS) has recently recognized that the Dexcom G5 Mobile CGM System qualifies as durable medical equipment under Medicare Part B. In order to be included in this category, the system must be defined as therapeutic CGM, meaning you can make treatment decisions using the device.

Note: Under the current ruling, the beneficiary may NOT use their smart phone to display glucose data and still be eligible for reimbursement for the purchase of a therapeutic CGM: you cannot use the Dexcom CGM app to display glucose data and be eligible for reimbursement from Medicare.

Am I the only one who finds this to be truly bizarre? I’m referring to the fact that they have just now allowed the G5 (always late to the party, Medicare…), AND not allowing users to access blood glucose information using their smartphone.

Or is this “old news?”

Dawg! Now I’m grinding my teeth again! Gotta’ stop looking at how Medicare handles T1D issues…

Bill


(joe) #2

@BillHavins Hi Bill,

how on this green earth will “they” know if you are using an application and smart phone? This may very well be a time to apply “it is better to beg forgiveness than to ask permission”. At the end, you will have to do what is right for you, I certainly know what I would do. cheers good luck!


(Dennis J. Dacey, PWD) #3

Hi Bill @BillHavins I read the same stuff myself and wondered. I’ve just returned from my quarterly visit to the endocrinologist and we had the discussion about your question - she [the endo] directed me to order the Dexcom G5.
Medicare approved reimbursement for the use of Dexcom G5 around November 2016 but Dexcom didn’t start shipping the “special or modified” Medicare devices until july 2017 - I seen the Dexcom box the says in uppercase letters “MEDICARE”. The transmitter supposedly has been reprogrammed to communicate only with the DME receiver. I’ve heard people say they can cet readings on smart phones.

I agree with you @Joe, how will anyone know. Advocacy groups are working to change Medicare “THINKING”.


(Bill) #4

Joe and Dennis, I’ll be the first to admit I just don’t get along with CGM technologies. I have absolutely no body fat and nowhere to put the sensor (that’s based on my earlier experience - things may be different now). But I thought I’d look at the G6 “just in case.”

Then I read the information on the Dexcom site regarding Medicare (see above). Heavy sigh. I frequently program microcontrollers (designs and programs of my own) so I know how to “turn off” feature sets in a microcontroller. If Dexcom has had to do that to get Medicare reimbursement I don’t even want to think about getting a G5. Of course, I could always get a bigger “kit” (bigger than the shaving kit I carry with me on trips to hold my diabetes supplies). Or, I could get another belt clip to hold the G5 receiver (that would be three including my pump, my cell phone, and the receiver - now that’s a “geeky” image).

At some point you just have to say, “No! I ain’t gonna’ do it!”

Joe, I don’t really care if “they” would never know. I’ve grown very weary of people believing they are “above the law,” or that regulations “apply to the other guy.” If that’s what Medicare demands I just won’t consider the CGM any further. I’ve been blowin’ and goin’ with T1D for many, many years. I doubt that not having a CGM will be anything more than “another inconvenience.”

I was just hoping the G6 was a possibility. Now I know.

Cheers!

Bill


(Kelly) #5

Hey Bill, yes, it’s absolutely ridiculous, my older sisters are both on Medicare and neither of them can use the Dexcom app or share their info with family members. One of them lives alone. Her daughter helped her get the Dexcom so she could be more secure about her mom’s safety. Then found out; her mom was not able to download the apps and share the info that might alert someone to a medical emergency. Get with it Medicare. Senior T1D’s need this technology🙁


(Dennis J. Dacey, PWD) #6

@BillHavins,
This is a link to the action I mentioned yesterday about people in Congress pushing CMS to allow Medicare Beneficiaries full access to CGM capabilities. https://diatribe.org/foundation/about-us/dialogue/senate-and-house-leaders-ask-medicare-cover-smartphone-cgm-use?utm_source=diaTribe&utm_campaign=09c527fa55-EMAIL_CAMPAIGN_2018_05_09_m162&utm_medium=email&utm_term=0_22467a8528-09c527fa55-150363185

I haven’t seen the letter but I’m assuming it is similar to previous statements telling CMS to listen to the medical professionals and, in the long run, probably reduce Medicare expenditures.


(ksannie) #7

I would not complain, if I were you. The government is always trying to cut down on fraudulent or wasteful Medicare claims. And the reason for not allowing use with a phone is that they do not want someone to argue that Medicare should pay for a cell phone to be used with the Dexcom. At least they are now covered. Before this approval patients had to pay hundreds of dollars a year out-of-pocket to buy them for the cash price, if they could even afford them. (I was one such person.)

As to use with something besides the official G5 receiver, they do work, but you must tell them each time you order supplies that you are ONLY using the Dexcom receiver. I tried something else for a week on the sly, but the readings were not so accurate. Not accurate enough to base treatment on. So I am happy to use the receiver that comes with the G5.

As to Medicare, they were not paying the pharmacy for my insulin, claiming they had no evidence I was using the insulin a pump (which was purchased on my employee insurance prior to retirement). Thousands of dollars of unpaid claims piled up at the pharmacy. I finally did my own appeal (which the pharmacy should have done correctly and did not), sending a copy of the purchase order for the pump plus evidence that they were paying the claims for my cartridges and infusion sets to another supplier I get those items from every 90 days!!

Another interesting thing about government agencies like Medicare is the age of their computer systems. I worked for a healthcare provider, and the payments for our claims were being transmitted by an old-fashioned dial-up modem until around 2014. The information could not be automatically downloaded to our computers. Again, this situation is due to all the congressmen wanting to brag about giving us tax cuts when they are up for re-election, instead of realistically funding vital things like healthcare.


(Donna) #8

Hi, I gavé recently ready that Dexcom is required to disable thé smartphone app when you order your dexcom g5. There are a lot of people working towards getting this policy changed. My fingers are crossed


(Dennis J. Dacey, PWD) #9

That is correct Donna, disabling the “phone app” was a requirement placed on Dexcom in 2016 to get CMS approval for the device.
Yes, we are working to have that condition removed from the enabling regulation.