I am having trouble finding a reliable supplier for Dexcom G6 sensors and transmitters. Have you found a company that proactively handles the paperwork so when its time to place an order there aren’t any problems? My health insurance is a private HMO plan and pays 100% IF I buy from a durable medical equipment supplier. Since it is an HMO the time spent on paperwork is extensive.
I’m currently buying from Minipharmacy. They are less evil than many of the other companies I looked at but they can’t reliably do the paperwork. They had weren’t following my insurances documentation for billing so a new Prior Authorization was required and they didn’t request one for two weeks after I placed my order. I had spares because I had read here about these problems on this forum. Minipharmacy refuses to send my next order early enough to replace my supply of spares.
Other companies I have considered:
Edgepark - Their customer service agents can only read from a script. They treat everyone like a medicare customer which means they require medical information they do not need. Collecting medical information they don’t need means they aren’t HIPAA compliant.
Byram - My endo first sent my prescription to Edgepark. I started getting calls from Byram saying they were calling to set up my CGM order. I answered a call from them, asked them to put me on their do not call list. My doctors office called me that day to say Byram called them and said I refused to get a CGM. I had the person confirm the prescription was sent to Edgepark. Ironically, if they hadn’t been running a scam I might have tried to use them.
US Med - A pending lawsuit accuses them of renting medical equipment they were repairing for other companies so I chose not to do business with them.
Advanced Diabetes Supply - They can’t bother to buy a domain for their company and instead use the domain of the owner’s previous company so I choose not to do business with them.
Diabetes Supply Center of the Midland, Healthy Living Medical Supplies and Solara were bought by AdaptHealth which is owned by private equity firms. These companies don’t typically offer high quality service.
Edwards and Pinnacle both use a unsecured web form that generates an email when submitting a refill request. Not HIPAA compliant.
I buy all my stuff at Express Scripts, because my company insurance favors them. They stink too, but I’ve never had horrible experiences. Maybe just mildly bad experiences. Good luck.
I’ve been pumping for over 25 years and as far as I can recall I’ve always used Edgepark with the exception of another which I tried for a few months a couple of years ago. I wasn’t satisfied with their service and returned to Edgepark.
As far as what Edgepark requires I honestly don’t know - when I’ve started on medical devices the rep has handled all the background work, working with my physician for any documentation they needed.
When I have had to call them - typically with an inquiry about when to expect my order - I’ve found them quite helpful. Anything from a script per se was related to their requirements, such as verifying insurance info which admittedly might take longer than I would like. Otherwise I’ve been write happy with them.
I found Solara to be better than Edgepark. You could look into them, if yiou want. None of the mail order suppliers are great, from what I’ve experienced. You just have to pick the one that’s the least problematic!
For me, Edgepark wanted payment up front, even though I knew my deductible was already met. Solara was willing to bill be me after they billed my insurance. That was my most important factor. Yours might be different. Also, keep in mind that most of the rules are set by your insurance - - things like replacing your spare supplies. Any pharmacy is limited by what the insurance will allow.
@spdif My Endo filed the initial paperwork and I ended up with Wellstart Medical calling and setting up the initial and follow-on orders. I don’t know anything about them except I’ve never had a problem getting my supplies and Medicare/Tricare For Life pay the bills regularly. They call every 30 days (I think that’s a Medicare requirement) or more often to check on current supplies of sensors/transmitters (it’s always been a 90-day order), take a count of what I have left of the last order, confirm nothing has changed insurance. They’ve started using text msg for the check-in and if anything isn’t in order ask for an immediate call to them. I don’t know how and HMO would deal with them or them with an HMO.
First and foremost, you need to check with your insurer as to which DME suppliers they either have contracts with or accept. An HMO is a managed care program, and requires the member to stay within its contracted network. Once you’ve done that, contact the DME vendors they have in their network. If your HMO does not have any DME vendors contracted, and they tell you to use a certified supplier, and assuming that you must use a DME vendor to get your CGM supplies and not a pharmacy, I’ve had good experience with Edgepark. They have a dedicated CGM unit, They have a process called Continucare which, if you enroll in it, allows Edgepark to contact you by email or phone to authorize your next order BEFORE your current order runs out.
Check with your HMO just to make sure about the use of a pharmacy to get your CGM supplies. If that’s a no, then no need to move on from there. If it’s a yes, CVS, Walgreen’s and Costco are the big suppliers of the CGMs in the retail pharmacy business. And you can set up an autorefill with all three of them.
But the final word comes from your insurer. Take it from someone who worked for years for several large insurers negotiating those contracts with DME vendors. Go to the source; don’t depend on the manufacturer’s rep or DME service rep to give you info.
I’ve stuck with Minipharmacy as the least bad supplier that is “in network” as part of my insurance plan. Minipharmacy isn’t good, I submitted them for a HIPAA violation this year and they got a stern talking to from HHS, but they make up for it by being small enough to actually be able to fix a problem like when they were quoting me medicare restrictions on when refills could be shipped instead of what my insurance allows.
There is a local pharmacy that used to be an in network DME supplier and I got to talk to the person who does their DME billing. The pharmacy dropped off the Anthem DME list because so many valid claims were being denied for no reason then eventually paid 3, 6, 12 months later. I can’t blame them. She said she only knew 1 local business in about a 200 mile radius that still deals with Anthem. Sadly they only sell things that are actually durable like beds and wheelchairs.
I tried getting a new glucose meter and lancets from Byram. After a month of phone calls where they couldn’t find the paperwork they shipped me, without my placing an order, a box of Delicia lancets. No meter, no lancing device. I tried getting a meter from Advanced Diabetes Supply. The new customer rep assigned to me was a real person but talked like an AI just stringing excuses together. I finally managed to call in on their day off and got an order placed but received the wrong meter and 3x the lancets that I ordered. It has been 3 months, I still don’t have a meter.
Edgepark is the DME division of hell. I tried to get an order of pen needles (pen needles are free if bought from a DME supplier because California employee health care + Anthem >
Bertolt Brecht) That took 3 months. I no longer have any spare pen needles. I was down to my last box and calling Edgepark saying I have 15 days of pen needles left. 14 days. 13… They hadn’t even submitted the prior auth request yet and when they did, they didn’t check the urgent box. Eventually one of the escalations reps just sent me two boxes no charge. But they substituted the cheap brand for the BD nano Gen2 that were the only reason I was talking Edgepark.
Here’s my current list of Dexcom suppliers. One of these days I need to add zip codes for those like me with insurance companies that insist on searching the network provider list within a geographical area. Also, AdaptHealth went on a buying spree a couple of years ago. I remember they bought Solara but there were others too.
Advanced Diabetes Supply
Byram
CCSMed
Diabetes Supply Center of the Midland
Edgepark
Edwards
Healthy Living Medical Supplies
Minipharmacy
Pinnacle
Solara (AdaptHealth)
US Med
Wellstart Medical
Better Living Now Inc.
Sorry to hear about what you’re going through. If you are still in need of a meter can you buy one out of pocket at your local pharmacy? The meters themselves aren’t necessarily expensive depending on the brand and features - it’s usually the strips that dent your budget. You might check Goodrx or Walmart for prices in your area…
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I don’t know if this is an option for you but I find sometimes it’s worthwhile to pay out of pocket for an extra supply of certain items such as test strips or pen needles, or even to purchase a meter, so you’ll be sure to have necessary items on hand, Submit a claim to your insurance for reimbursement after the fact rather than jeopardize health and be frustrated by waiting on suppliers or claims coordinators to get their acts together up front.
I’ve used Edgepark for a very long time. I had an issue a year or so ago and switched to another supplier but went back. Aside from that one issue over many years I’ve been satisfied with them. If you don’t mind my asking, what are you referring to when you say Edgepark - treat[s] everyone like a medicare customer which means they require medical information they do not need.? I do find it annoying to have to get periodic preauths and I know they require information from the physician for compliance purposes, but I haven’t encountered anything I thought was out of line, and the company I temporarily switched to had to jump through the same hoops regarding processing so I don’t know that it is supplier specific. Thanks.
Amazon carries BD pen needles - $8.39 for a box of 100. I find it faster and easier to buy from them, instead of going through my Medicare Advantage plan. I use each needle multiple times, so a box can last me close to a year.
Regarding Edgepark (and other DME vendors) using Medicare guidelines even if you don’t have Medicare before sending out ordered supplies, this is the common practice. Most major health insurers find it best to use the same guidelines that Medicare uses to determine the need for a prescribed item. That is not to say there aren’t exceptions, especially if an insurer gets enough complaints from its under 65 population about something. But generally, since Medicare guidelines are based on extensive research and data provided by the pharma or DME manufacturer, and passed the FDA approval process, it’s not a bad thing for private insurers to use. I should know. I was in charge of DME contracting and reimbursement at two major insurers.
You keep referring to HIPAA violations. As someone who was involved in providing the Feds with suggestions and data as HIPAA was being developed, I can’t understand what you’re writing about. A pharmacy, DME vendor, or any other provider of a service that must be pre-authorized before dispensing or performing, is allowed to request the kinds of information you’re referring to in order to get the necessary pre-auth. HIPAA was designed to prevent providers from illegally sharing or passing on a patient’s healthcare info without that patient’s permission. When a supplier or provider receives a prescription for a medication, item or service that requires pre-authorization by the payer before it can be dispensed, that info can be provided to the dispenser with the condition that the info is not to be shared or used for any other reason. The other piece of HIPAA establishes the portability of health insurance coverage from one carrier to another, thus eliminating the waiting period when you switch from one insurer to another through change of jobs, loss of job requiring the self-purchase of insurance, etc.
I really am sorry you are having so much trouble getting your supplies. Like wadawabbit, I’ve used Edgepark for some time (about five years) with no issues. Check with customer service at Anthem. I could swear that a few years ago they eased their regs to allow members to get their meters, supplies and even CGMs from in-network pharmacies such as CVS or Walgreen’s.
Hi @wadawabbit I edited the above removing an off topic item - as a community we should strive to help, for sure, but our advice should stay “on label” whenever possible. IM me if you need to discuss.
Thanks Joe. That is a great description. I could use that describe half of my diabetes healthcare experiences.
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