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← Return to Entresto. Would appreciate any discussion, pros, cons.
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Entresto. Would appreciate any discussion, pros, cons.
Heart Rhythm Conditions | Last Active: Sep 17 10:33pm | Replies (66)Comment receiving replies
@abob
It is not Medicare where the issue is. It is the pharmacy not understanding that DRE equipment and insulin used specifically for that DRE is under part B medical. My wife has a G-7 and automatic insulin pump that she injects insulin into the pump and it automatically releases insulin into her body. That was put under DRE and part B by Medicare. Medicare would pay the 80% and then my insurance company BCBS will pick up the 20%. I should pay nothing.
Our issue is with CVS. They try to charge it to Part D which Medicare won't pay as comes under DRE. They try to charge it to BCBS. We ran into an issue with BCBS not recognizing the bill address from CVS as they use a bill paying service not their pharmacy location. So BCBS says the bill's address is not in network and won't pay.
I tried to get CVS to use another address, no luck. Tried to get BCBS to accept the bill payers address as it was still CVS pharmacy charge, but they use a billing company, no luck.
Contacted CVS, no luck. Contacted BCBS supervisor, no luck. So, we just pay the insulin costs charged to us by BCBS prescription which runs us $60.00 co-pay for 90 day supply.
Replies to "@abob It is not Medicare where the issue is. It is the pharmacy not understanding that..."
We use the pharmacy at Costco which saves us money and they are much more responsive to any issues we may have.
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Very confusing. Seems to be conflicting/unclear G7 as DME info from CMS vs DEXACOM?
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CMS booklet:
https://www.medicare.gov/publications/11022-medicare-coverage-of-diabetes-supplies-services-and-prevention-programs.pdf
MONITOR & PUMP - PART B DME:
“The Dexcom G7 continuous glucose monitor (CGM) and automatic insulin pumps are generally covered by Medicare Part B as durable medical equipment (DME). Medicare Part B covers these items when prescribed by a doctor for managing diabetes.”
INSULIN - DRUG CAP:
$35 (or less) for a one-month supply of insulin if you use an insulin pump that’s covered under Medicare’s durable medical equipment benefit. The Part B deductible doesn’t apply.
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DEXACOM website:
https://www.dexcom.com/en-us/faqs/medicare
If you use the receiver (classified as DME) to display glucose data, Medicare covers CGM system supplies and accessories. There is no Medicare coverage if the receiver isn’t classified as DME. However, you can use the app (on your smartphone, smartwatch, tablet, etc) as well as the receiver.
Here are some examples of how you can use a smart device and receiver under Medicare:
Use both a receiver and a smartphone throughout the day
Use a receiver some days and a smartphone on other days
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GOOD LUCK:
Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.