Trouble with Dexcom insurance coding


(Annika) #1

My daughter has had the Dexcom CGM for 5 years, the parts were always billed under A codes for diabetic supplies. Now United Healthcare Oxford says they have to bill under K codes for DME due to a Medicare ruling. For diabetes supplies we only have a $40 copay but our DME has a $2500 deductible! Is anyone else having similar problems with insurance coverage of Dexcom CGM for their children not on Medicare?


(jdsnyc1421) #2

Hello, I am in the same boat. My work recently switched to United Healthcare Oxford, and I am now trying to receive my Dexcom Sensor supplies. I was told that I have to now go through a 3rd party supplier for these supplies; UHOxford does not affiliate with Dexcom directly. The 3rd party being used, ‘Byram’ is currently attempting to process the order. They are reviewing medical records from my Endo. The deductible is the same for me, $2,500.00.
As well, being that these supplies are treated as DME, I’ve read UHOxford will only cover %70 of the (inflated Health Insurance) price. And I’m assuming this is after the deductible is met.

I will update with any new information.Please do the same.

ps. I am having the same issue with OHOxford concerning my Omnipod Pod Pump supplies.

Does anyone know generally if/when CGM and Pump supplies are treated as DME, or diabetic supplies?

john


(Annika) #3

Sorry you’re having the same problem with UHC! I spoke with Dexcom directly and while they don’t contract with UHC in NY where I am, they do contract with UHC in CA and they said that with UHC CA, the Dexcom bills are going through with the A codes for diabetic supplies instead of the K codes for DME. My daughter has a doctors appt on Thurs so hoping they will be able to help sort this out - will post updates. My daughter has the minimed and UHC does contract directly with Medtronic so we have been getting all her pump supplies from them and covered by the diabetic supply benefit, not DME (at least so far!)