We have all seen bills with outrageous charges on and we all “hope” that our insurance company pays a reasonable amount. The supply company I use for test strips charges $86.71 per box of Aviva test strips but my insurance only allows $31.09. What my insurance pays for those strips certainly seems like a reasonable amount to me – that is how you would think that it should work when companies charge inflated amounts.
I used to be a bean counter so I totally understand the need to make a profit. I prepared financial statements for various companies and would figure out why a company was losing money. I did job costing for different projects. I really, really get that you don’t want to lose money on stuff but medical supply billing is just insane.
Last November, I got a Navigator. The day it was supposed to ship, I had an appointment with the doctor that signed the paperwork. She told me that the sensors were $700 a box. I said that might be what the supply company charges, but that is not what the cash price is so I doubt that my insurance company would pay that. When I received a copy of the DME statement, I almost had a heart attack when I saw that the supply company had billed $750 a box for the sensors and my insurance had also paid $750 a box for them. Cash price was a little less than $400.
In January, my Navigator died. In March, it was clear that Abbott would not be resolving their backorder anytime soon so I decided to start the process to get the Dexcom. Right after I started that process, Abbott came out with an offer to everyone with broken Navigators to sell them back for $2,000 plus the sensors. The day after, Dexcom came out with an offer to Navigator users to buy a Dexcom for $999 – you got the Dexcom plus 4 sensors. I called Dexcom and they had just received everything they needed from my doctor so as soon as I got the money from Abbott, they would be able to ship the Dexcom. They were supposed to let the supply company know that I accepted their offer.
Apparently, no one called the supply company because they called me that they had approval from my insurance to ship the Dexcom. Because I did not have the money back yet from Abbott, I decided to let them ship it. I received it on April 21st. The check from Abbott cleared my credit union on May 6th, and I returned my insurance companies portion of the money to them. Because I have hypo-unawareness, I was glad that I did not have to go without a CGMS any longer than I had.
I never received the DME statement for April and meant to call about it. In the meantime, my July 21st sensors had been shipped. I logged onto my insurance’s website one night and saw the claim for the July 21st sensors. They only put medical and pharmacy claims on their website, not the DME stuff. You can’t see the details until it is finalized. When it was finalized, I was able to click and see what they charged – $2.327.64 for three boxes of Dexcom sensors that works out to $775.88 per box! The claim had been denied. I called my insurance right away and was told that their DME department was closed for the day. The reason that it was denied was because it should have been processed as a DME item and they processed it as a medical claim.
I called back a couple days later to request a copy of the April claim. I just received that. In April, the supply company charged $600 per box and my insurance paid $600 per box. But 3 months later, they raised their price by $175.88 per box. It is the exact same sensor so someone please explain to me what could cause the price to go up that much.
The supply company also charged $1,100 for the Dexcom transmitter and $750.00 for the receiver – a total of $1,850 for what Dexcom would have charged me $999 (not to mention Dexcom’s deal included a box of sensors that the supply company got paid $600 for). At least my insurance denied the $750 as a duplicate claim. However, they still paid $1,700 for what I could have bought from Dexcom for $999.
In March when I first started looking into the Dexcom, the cash price for sensors was $275 a box. I thought I heard the prices went up, but Dexcom no longer has that information on their website. When I Googled it, I found a post from CWD on May 20, 2010 from someone that said she does not have insurance coverage and pays $275 a box. If people can buy sensors at $275 a box, surely my insurance company does not need to pay $775.88 per box! And $275 x 3 = $825 so they practically paid for 1 box what 3 boxes should cost.
In, June, I got a pump and the pump stuff was also on the DME statement with the Dexcom. The supply company charged $1,050 for the infusion sets. You can buy those same infusion sets on the Animas site for $405. My insurance paid $375. They billed $225 for the cartridges and those are $109.50 on the Animas site. My insurance paid $97.50 for those. That is how this should work!
Before the supply company shipped the pump, we discussed what color Ping I wanted and which infusion sets. When the box came, they had also sent a box of skin preps – granted, I needed those, but I had some leftover from my Navigator so I really did not need the ones they sent nor want the brand that they sent. If someone had bothered to say they were shipping them, I would have said no. Since I am switching to Orbit infusion sets, I won’t need skin preps. Even more surprising than the skin preps were two packages of Energizer lithium batteries and the packing slip was marked “Animas lithium batteries” making it sound like they were special Animas batteries. There was a charge for $59.00 labeled “Miscellaneous DME” – I am guessing those two items were lumped together. My insurance company did not allow it – at least there is some justice!