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Insurance vent -- Tufts Direct/Network Health and Byram/DSC

Discussion in 'Parents of Children with Type 1' started by nebby3, Jul 17, 2015.

  1. nebby3

    nebby3 Approved members

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    We have new insurance as of 5/1 so I filled out the paperwork for a new Dexcom. I really want the Share since our reception is bad at night. Well, Dexcom sent our into for DSC/Byram since they said our insurance (which is Network Health which is owned by Tufts Direct) does through them. I was fine with that since we used them with our old insurance too. Now DSC says our insurance company says they can't use them. But Dexcom said they did work together and they have covered sensors for us through DSC the last couple of months. I told the DSC lady this and she is looking into it again but this is so frustrating. Anybody else have Network Health or Tufts Direct and have any insight? We've had completely unrelated problems with our new dental insurance company too so I seem to be always on the phone, half the time on hold, with these companies, trying to tell them that yes, we are in their systems, and yes, they do actually do things they say they don't do.

    Mostly needing to vent but any insights are appreciated.
     
  2. caspi

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    Don't necessarily believe that what DSC is telling you is the truth. :wink: We had a lot of issues with them when Byram took over. When I'd call to check on the status of an order, I would be told a number of different things: first they said they needed an Rx from the doctor (they already had the Rx), then they said the Rx wasn't correct so they needed a new one (same Rx the doctor always sends), then they need a log book (our insurance never requires a log book). It was frustrating! My best piece of advice is to stay on top of DSC and call every.single.day.
     
  3. nebby3

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    Sigh. It shouldn't have to be this way. The lady at DSC seems to be working hard for me now. She insurance company claims department agrees they cover things but the pre-authorization department doesn't have the right codes or something. I will sat DSC messed up initially because they used our old insurance information even though I had filled out the forms with the new info and they had already used our new info once to fill a sensor order. Our first Dexcom (also through DSC) we got in like 4 days over a holiday weekend. This one has been at least 4 weeks and still counting.
     
  4. caspi

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    Our third (and final) order with DSC took 3 weeks. Same insurance, authorization was still in place, etc. But as I said above, every time I called I got a different excuse. What was even more frustrating is that everyone at DSC is just so darn nice so it was hard to get upset with anyone, lol. I hope you're able to get things straightened out soon!
     
  5. msschiel

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    We have UHC and PA Access for our insurance. We are currently trying to get a t:slim. I am praying that they will take the PA access so we don't have to pay anything oop. We don't have anywhere near our deductible met because the secondary insurance picks up anything the insurance doesn't pick up. We had BCBS until May 2014, which was great. I have had several issues with UHC not covering things that should be covered. I never had to deal with much insurance stuff until ds was diagnosed almost 2 years ago. I am waiting to hear back from Byram. Just want to know what will be covered and if we are responsible for anything OOP.
     
  6. Beach bum

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    Not ideal, but I have started paying out of pocket for DSC to overnight CGM supplies. Only way I could guarantee our supply got to us before we ran out. this last order they kept insisting our insurance was bouncing the order because we have twins and "that was confusing the insurance companies computer system! Grr.
     
  7. msschiel

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    Thanks for the heads up. Sometimes I have trouble at Walmart picking up the secondary insurance, which is a pain. I was finally able to get a hold of someone over at DSC and it appears that they do take the PA access card, so we should know in a few days. Our deductible is high for UHC, so there is no way we could have afforded it out of pocket at this point.
     
  8. nebby3

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    An update on us -- we are still waiting for the new Dexcom. It's been almost 3 months. We've switched from dsc to Neigjborhood diabetes but it should not have taken so long to find out our insurance wouldn't cover through dsc. This is a replacement CGM for us so we can wait but it has been a long frustrating process and I'm still worried we won't get the CGM covered. How much are they oop?
     
  9. msschiel

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    No clue how long it might take as this is our first time trying to get DME, but i hope you can get your dexcom quickly. Not sure how much they are OOP since we haven't tried for one yet. I wish there was a more simple process to get these things taken care of.
     
  10. nebby3

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    Our first Dex we got in less than a week over Thanksgiving weekend so our experience this time is presumably not typical.
     
  11. rgcainmd

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    Shortly after my daughter was diagnosed (the same day), I feverishly researched the different options for pumps and CGMs. It didn't take me long to decide in favor of the Dexcom. I simply called the helpful Dexcom folks directly, told them I wanted their product for my newly diagnosed daughter, they asked a few simple questions (endo's name, phone number, daughter's name and DOB, health insurance company and policy number) and THEY did the rest for me. If memory serves, within 2 weeks of my initial call to Dexcom, they had gotten my insurance company to agree to coverage and had orders faxed to my daughter's (soon-to-be-ex) endo, who signed the orders after I made it clear that I would hound her until she did. I believe it was less than a week later when a nice big box from Dexcom arrived at my office.

    Have you tried contacting Dexcom directly? They seemed perfectly delighted to do all the "legwork" for me because selling their product is how they keep in business...
     
  12. nebby3

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    I love Dexcom but they contributed to our issues by bumping our case to dsc which was supposed to work with our insurance but apparently doesn't. That took about 2 months to figure out for some reason. I got a letter today from our insurance saying our sensor order from May ($700+) wasn't covered even though I had dsc run our benefits ahead of time and they said it was plus I've had their employees tell me it was paid.
     
  13. msschiel

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    Ugh! hope you can get that figured out.
     
  14. rgcainmd

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    Is there no end to the cr@p we go through with insurance companies? IMO, they are the root of all that is evil... Makes me want to tear my hair out just reading about your plight.

    Do you think it would be worth your time to contact the Dex folks one more time and explain to them the chain of unfortunate events to date and ask for their assistance? It may be an exercise in futility, but maybe not. Please keep us posted.
     

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