Dexcom Surprise Medical Billing

In November my husband received a preauthorization form from his doctor to get dexcom cgm. He spoke to Dexcom, who said they reached out to his insurance and were told he had met his out-of-pocket medical spending for the year and that the cgm wouldn’t be an extra cost. Great! Now we’ve come to find out that this wasn’t true, and that he owes +$2,000. Has anyone had any experience with this? We have documentation on all ends, including that initial call with Dexcom that said this wouldn’t be an extra cost, but no one seems to care.

Any advice or experience dealing with a similar experience would be greatly appreciated.

Welcome to TypeOneNation @AStolz Aurora, DEX and all the rest will say that what they tell you is an estimate and final costs are only when you receive an EOB from your insurance company. I would threaten DEX and tell them they are taking it all back at zero cost to you and see if that lights a fire to get some service. It is likely you owe the deductible, but it could be a paperwork malfunction at your insurance company as well. Did they process this last year or this year? Good luck.

If you haven’t already done so I would re-read their policy details to see how your durable medical equipment is covered once you’ve met your deductible: specifically if it’s covered at 100%, or if there is a co-pay.
I’ve occasionally resorted to reading the details of their plan verbatim to my insurance for clarification if I’m wrong, or correction if they are. Sometimes there is an error in the way the provider submitted the claim - if insurance tells me that’s the case then I do a three-way call so they can “talk technical” with each other. I’ve discovered the hard way that it’s very time consuming and ineffective for me to call back and forth as an intermediary relaying messages - and often starting over from scratch with a different person. Wishing you the best in getting this straightened out.

Have you spoken to both your insurance provider’s claims and Dexcom’s billing departments?

Please tell us the following: is he on a pump? Is he on Medicare primary? Does your insurance company treat CGM systems as DME if they are also on a pump?. From that, you can work the rest out. Medicare treats pump user-CGMs as DME, including the sensors; in fact they treat the insulin as DME.