I hesitated to even write about this because I feel like I complain about my insurance woes far too often. However in this case in particular, I am shocked at the behavior of both the parties involved and the way in which they both show very little care for their customers.
The very first thing I did when my new insurance started on March 1st was make an appointment with an endocrinologist. The very first thing I did when I walked into the endocrinologist’s office was ask for a prescription for the Dexcom G4. The endocrinologist quickly agreed and my paperwork was started the very next day.
The forms quickly went from Dexcom to my insurance company. I received a call from my Dexcom representative who explained that my insurance uses a third party supplier and that the supplier would call me in a few days to confirm my benefits.
I knew my new insurance policy practically word-for-word so when I finally received the phone call, I was just pennies off from the price that the third-party representative quoted. That price included my deductible and then the percentage that I owed on the balance according to my PPO insurance plan. Let me repeat this point because it is quite important for the rest of the story – my insurance company and this third party supplier communicated with each other to provide preauthorization and a price quote on this benefits claim. I paid the remaining balance and asked for a receipt for my tax records.
I received the Dexcom a few days later and happily began using it. I had no idea anything was wrong until about a month later when I was on my insurance company’s website looking for an eye doctor. The home page shows a list of the most recent claims. Under the Status column, most of the claims have the word Processed in green. One claim, however, lists Denied in bold black letters. I clicked to open the EOB and noticed it is the Dexcom claim. In the explanation, it states that the claim was denied because my insurance company did not receive an “itemized list of charges.” In addition, every claim after that one was paid out at the wrong amount based on the denied claim that should have met my deductible.
My first call was to the insurance company. They explained that they needed a manufacturer’s invoice, provided by the third party supplier, to process my claim. Obviously, my second call was to the third party supplier. I explain the problem and the representative on the phone stated that he would fax over the invoice immediately. He noted that it sometimes takes a week or so for the insurance company to catch up on the paperwork. I kept on eye on the status of that claim, and it continued to read denied.
When I called the insurance company again to check on the claim, I received the explanation that the third-party representative had sent over a packing slip, not the actual invoice that they needed. The insurance representative offered to initiate a three-way call with the third party supplier. During that phone call the representative explained yet again what they needed and the third party supplier representative agreed to send over the information. I finished that phone call with hope that the situation would be quickly resolved.
At this point it was now late June. Since the initial Dexcom order I had several other orders with the third party supplier and they had all resulted in difficulty and error. Out of extreme frustration, I took to twitter to complain. I was directed to write an email to their social media account.
My strongly worded email resulted in a phone call from the third party supplier. The representative explained that they have a contract with my insurance company. That contract determines the price for the Dexcom and the documentation needed for the claim to be processed (e.g. why PWD are sometimes required to provide BG logs). According to the representative, the contract DOES NOT include the requirement for a manufacturer’s invoice. Therefore, the third party supplier refuses to provide the invoice.
I asked my insurance company if I could just called Dexcom directly and get the invoice from them. The answer was no for the same reason that the third party supplier won’t produce the invoice to the insurance company. The contracted rate from the third party supplier is a different (likely higher) price than the actually price from Dexcom.
During that same phone call with my insurance company I mentioned that I had that receipt from the third party supplier that outlined my insurance coverage and my out of pocket costs. The insurance company representative asked for those details and said he will process the claim for the amount of money that I have paid. He said that if the supplier wants the rest of their money, then they will produce the invoice.
Granted that last conversation took place the first week of July, and that EOB still sits in my account – denied.