My insurance changed 1/1/22 to Cigna Oscar. I have dealt with over 10 different people on DME, pharmacy and Medical side and NO ONE can give me the same answer as to how Dexcom G6 and Tslim pump supplies are covered. I’ve looked through all the formulary plan documents. I even rec’d an authorization from pharmacy side (Express Scripts) to only be told that was a mistake. Now I’m struggling with DME side again.
My current DME supplier Byram sent me a box of supplies after I asked them TWICE not to send until I could get my coverage/authorizations straightened out. They confirmed both my requests are documents. They sent me the pump and dexcom sensors anyways. I’m now being told I can only return the pump supplies but not the sensors. I’ve of course complained but no one will call me back. I do not have a legitimate authorization for these supplies I’ve rec’d and I am not confident with those I’m working with Cigna Oscar that they will back date, if and when it EVER gets authorized.
My employer is now getting involved and I’m going to get the insurance commissioner involved. I may even get my own attorney because it is that big of a mess these last 4 weeks trying to get straight answers.
Is there anyone here or at JDRF that can advise or advocate? Has anyone else been through something similar that can advise me on getting support? Anyone that has dealt with Cigna “Oscar” would be helpful.
Dealing with a chronic disease is hard enough. Dealing with insurance companies who don’t know their own policies is unacceptable. Thank you!
I wish I could help you with your issues but I’m afraid I’m out of my league. I just wanted to suggest you look for a different supplier. I’m with Edgepark - they served me very well for many years and I tried another company last year and just returned. Your reps should be able to recommend suppliers that accept your coverage of you need help finding them.
I have tried handling supplier/insurance differences on my own, to no avail. In my case I was told something which I passed on to the other party, only to find out more was needed - suffice it to say I was going back and forth like a tennis match, and with the terms they used they were speaking a different language.
I went to my device rep and somehow or other things got worked out between the supplier and my insurance - I believe those two conferred by phone and ultimately came to a resolution.
Regarding the charges, if you paid by credit card you could start a dispute with the company.
hi @Jcolburn9039 welcome to the forum. This is a self-help group of people with T1 and generally not directly related to the JDRF. In my experience, the actual insurance policy regardless of the underwriter, depends on what was asked (and negotiated) to be covered and how, by your employer. Still there are some generalizations: typically g6 sensors are pharmacy and not DME because they last 10 days. the transmitter (“could”) be DME at 90 days, and a pump like the Tslim are almost always DME. My insurance covers g6 and transmitters as pharmacy benefit (with copay and deductibles). My insurance covers pumps as DME, with a specific DME deductible. I hope you get it figured out. good luck!