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WT...H?

Discussion in 'Parents of Children with Type 1' started by virgo39, May 29, 2014.

  1. virgo39

    virgo39 Approved members

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    So based on the information that I received from the Dexcom representative (who gave me the retail, cash price without insurance, for our Dexcom "startup" kit) and the representative from Carecentrix, which handles the Cigna billing (who gave me an "estimate" based on Cigna's "negotiated" price), this is how it plays out:

    Transmitter: Cash price-$599; Cigna "negotiated" price-$716
    Receiver: Cash price-$599; Cigna "negotiated" price-$574
    Sensors: Cash price (per box)-$349; Cigna "negotiated" price-$452

    Carecentrix rep repeatedly used "negotiated" in referring to the price.

    Ironically, I had actually joked with the Dexcom rep, who told me that I had to contact Carecentrix to find out the price--even though Dexcom was actually selling me the products--that it was "inconceivable" that the Cigna "negotiated" price would be more than the cash price.

    "You keep using that word. I do not think it means what you think it means."

    When I called to complain to Cigna, the rep told me she could "apply my complaint to my account." When I inquired as to what that meant--she indicated that it means she will make a note of my complaint, which will be sent to the "complaint department", which will not get back to me. When I indicated that this was ... not acceptable ... they referred me to the Illinois Department of Insurance.
     
  2. mamattorney

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    I don't think it's unusual to charge insurance companies more than a cash customer. Then they negotiate with the insurers to an agreed upon price that's likely less than originally charged. It seems strange, but cash is king and they probably allow the insurance companies to pay on a delayed basis and charge them more for that privilege.

    That said, those numbers seem funky. For what's it's worth Dexcom charges Blue Cross Blue Shield of Illinois $1,497 for 4 sensors ($374.25 each), but only get paid $909.72 ($303.24 each).
     
  3. LoveMyHounds

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    Unbelievable...
     
  4. rgcainmd

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    This is an excellent example of what is wrong with the health insurance industry in the U.S. Where does CIGNA get off charging more than the cash price directly from Dexcom (especially in light of the fact that CIGNA/Carecentrix likely gets a price break because they buy Dexcoms "in bulk")?!?!? If there isn't already a law, there certainly should be!
     
  5. mamattorney

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    Well, it starts with Dexcom charging the insurance company more than a cash customer . . .
     
  6. rgcainmd

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    I'm fairly certain that CIGNA (and BCBS, Lifewise, PacificSource, PacifiCare, United, and all the other Big Name health insurance companies) have enough cash money in their vast coffers to pay Dexcom in cold, hard cash if they so desired.
     
  7. tom_ethansdad

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    Inconceivable!
     
  8. virgo39

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    Dexcom should sell its product for as much as anyone will pay for it. The fact that the carrier is paying more than retail is, IMHO, more a reflection on its fairly unfettered ability to pass those costs on to those paying for the policies.
     
  9. rgcainmd

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    You hit the nail right on its ugly little head! As a physician, I see day in and day out the unbelievable crap health insurance companies get away with! I can't even prescribe effective medications for my patients half the time.
     
  10. Jordansmom

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    Not to correct you on your own insurance, but we have had BCBS of Illinois while using the Dexcom and those charges cannot possibly be for 4 sensors. $909 is much more likely to be for 3 boxes of 4 sensors (3 months per order). That's $75.75 per sensor. Much closer to typical insurance costs.

    I searched Dexcom sensor costs on the forum and your own post popped up
     
  11. mamattorney

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    You are right - I have no idea what I was thinking. 3 month supply = 3 boxes of 4 sensors each on one bill. Mea culpa on that one.
     
  12. sincity2003

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    This isn't new or unusual. My son's pediatrician has an after hours clinic. If you don't have insurance, they charge a flat $75 visit fee. If you have insurance, at least in our case, they billed our insurance company $350, and got paid $175, except we had to pay it because it went towards our deductible. I only found out about the cash price because a very good friend of mine took her son in on the same night we were there and she told me they paid $75 because she didn't have insurance (this was a good 5 years ago). I asked about it and went round and round with the office manager about it. She told me it's perfectly legal.

    Another more recent example: DS had an endoscopy April 30th. We paid $361 the day of the procedure, which was our deductible. They billed the insurance $12,000. They were paid $961, plus the $361 we already paid. So they got $1300 give or take for a $12,000 bill.

    This is what's wrong with our insurance. It isn't about people having/not having it, it's about how much a doctor has to bill an insurance company just to get paid something close to what they should.

    Another racket is test strips. When we order through express scripts (usually our first order of the year, since we haven't met our deductible yet), we pay $298 for a 3 month supply, but retail cost is something like $1300. When we get them through DME coverage, we pay $78 for a 3 month supply. How in the world does that work?
     
  13. quiltinmom

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    Yes, it is stupid, but that's the insurance game. One of my kids needed a procedure done once and that was what the dr said--the cash price would be less than the insurance price, because they have to charge more so they can then negotiate it down. There are great ways to bring health care costs down, but it's too bad nobody will do it. And it's all about money--those who have it, those who don't. $1300 for 3 months of strips???? That's a broken system if I ever saw one.
     
  14. cococay

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    Incidentally, we have Cigna (of st. Louis I believe) and our order of 3 boxes of dex sensors were billed at 1045.83.

    I doubt this matters, but we ordered through edgepark, they billed carecentrix and then we paid the 104.58 (90% coverage) to carecentrix.

    I can't remember what they billed for the system because our DME is 100%.

    Just curious, are you getting any adhesive products covered under Cigna? (Like tegaderm, skintac, etc) if so, who are you using. We were using edgepark, and all was fine till we added my son's Medicaid info and they refused to provide for him, won't even let us waive them filli1mg with Medicaid, they refuse to provide services to anyone with Medicaid,. I can't find anyone else yet who can process support products through our medical benefit with Cigna. No, we were not behind on bills or anything close to that, technically, they should refund what I had paid.

    If there we more suppliers who could file with Cigna it wouldn't be such a big deal, but there doesn't seem to be anybody else.
     
  15. virgo39

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    Not sure I understand your question, but I don't believe that any adhesives are covered.
     

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