UHC Insurance Rant

Just a frustrated rant about UHC. I am on the Omnipod and Dexcom G6. I started with the G6 in Dec and got it through Walgreens. Now UHC is saying it can’t go through pharmacy, must be done medically through Byram. I was getting it at Walgreens for $350 for 30 days. I paid $40 copay and then UHC paid $310. Now going through Byram, the 90 day cost is $3,750. I pay $177 and UHC pays $1,593. This is a $57 (48%) increase for me, and a $663 (71%) increase for UHC. I can’t understand how this a better move. It also means when I fill it next year, I’ll be halfway through my deductible with just one refill. Anyone have similar experience? I am currently battling with UHC to go back to Walgreens!

Hmmmm. I also have UHC. I got my first G6 in October of 2018. When I first went through pharmacy (I usually get everything from Tom Thumb grocery store. I guess I’m too lazy to shop around.) my copay was going to be about $600!! With the receiver, it would be an additional $400. I had them send it back.
I then learned it was supposed to go through DME and that meant Byram. On my first order of 2019, I had to pay $750 copay. That met my deductible. My next order will cost $375. I guess our plans are significantly different. I’m in Texas. I don’t know if that makes a difference. I’m actually jealous. But I understand your frustration. Pricing never makes any sense to me (and certainly never seems rational).

I learned to double the life of the sensor. That will save me some money.

@sgwilson my deductible is $3000 and then 10% cost. I usually hit the deductible by April/May. I was glad when we changed to UHC as my pods cost $2300 with Cigna but only $900 with UHC. But the CGM cost is ridic! I just don’t know why they’re forcing a change that costs me and them more. Lucky I work in HR, so I am escalating to my broker and UHC contacts for some resolution. I’m super interested to know how you’re doubling the life of the sensors! Are you keeping the sensor # and retyping it in when you start a new one? Just add something like a Simpatch to keep it staying on longer?

@kate4728, @sgwilson, it is not so much the Insurance Company that “fronts” for a self insured plan, but costs to individual members is based on the plan dsign and the elected deductibles and co-pays.

UHC is the name on my member card and I got my Tandem t-Slim pump and supplies, my Dexcom G5 and supplies through Byram all with minimum out-of-pocket costs. All that I have paid is the 20% DME on the insurance company discounted cost for the Tandem pump, in January, and the Dexcom receiver last July and the replacement transmitters. The infusion sets and sensors are delivered by Byram without co=pay.

What I did choose, was the option with the highest monthly “premium” which for me in older age with several “specialist doctors” and lots of medical stuff going on turns out to be the less costly plan over the course of several years.

@Dennis my plan is not self insured, we’re fully funded. I get insurance through my work, so there are no options. Based on your age, I’m assuming you have Medicare and then UHC is the carrier for your supplemental plan. So it makes sense if you have next to nothing copays.

I just don’t understand why UHC would force me to move my CGM from pharmacy to medical coverage. It is more expensive for them and me.

@kate4728 I found the instructions on the Internet. I use the receiver. There are instructions if you use a phone App, but they are more complicated. I hate my phone anyway.
It’s easy.
The receiver warns you the sensor is about to expire (you need over 2 hours left before expiration). The receiver reads every 5 minutes. Right after you get a new reading (very important), stop the sensor. It will say new sensor. Put in the SAME number and start it. The receiver and sensor can’t have any contact for the 2 hour warm-up. Put it far away from you or you can put it in the microwave (don’t use the microwave, obviously). After 2 hours plus a little for insurance. Take it out. It should start reading about 15 minutes later. My last sensor was working well at 20 days and I thought about keeping it on, but it was starting to come loose and I didn’t like the location that much.
Sometimes if it’s on it’s 2nd go, the reading start to get a bit off. I’ll recalibrate a couple of times. If they’re still off, I’ll change sensors.

Disclaimer: This is not FDA approved and I am not recommending that anyone follow my “bad” example. (Just covering my ass. ) Lol

@kate4728 Sorry. Another disclaimer: I restarted mine this morning and it keeps going through periods of no readings at all. I’m thinking the sensor is going bad because it started doing this yesterday. I’ll leave it on for now, but may have to change it anyway. Oh well. It’s always worth a try IMO.

@sgwilson thank you for the info. I def think it’s worth a try. And def good to know for emergency situations. In fighting with UHC, I had 2 days with no sensor and hate using my regular glucose monitor.

@kate4728You’re welcome. I don’t use a pump and I’m not sure it works with the interconnectivity of a closed loop system. I found the instructions when I Googled something like “extending the life of a Dexcom G6”. You might find more info that way.