Think Twice Before Bringing Your Dexcom Data to Your Next Doctor's Appointment

Ann Bartlett Health Guide July 19, 2012
  • Your health care is always a work in progress. Wouldn’t you agree?  And every time I hear about someone going to see their doctor, for a regular scheduled appointment to have a physical or an annual, and they are completely confident they get the best care, from the best doctor, in the best hospital, I am envious, and then I feel dubious that they know what they are talking about.

     

    Could they really have it all?  Because I have to be on my toes at every appointment; I have to scan every bill and I have to work at this partnership called health care.  It’s not bad and there are highlights when it’s working well that give me a deep sigh of relief. Lately, my experience has been one of intrigue, frustration, and now becoming a call to action.

     

    I’ve been very happy with my endocrinologist for several years. I met her when she was a resident working on her fellowship seven years ago. After she finished her fellowship, I followed her to her new practice in a different hospital.  I remember the first time I called her new office for an appointment and the receptionist asked, “When would you like an appointment?”  I said, “What’s her first opening?” the receptionist replied “Tomorrow 10 am!?” That sure didn’t last long!  

     

    I helped spread the word about my wonderful experience with her and her commitment to her patients, and she has often said that many of her patients have commented that they heard about her through me. I know I can ask for the random, one-off test, like I did for AAT, and we decide, as a team, if it’s interesting or worth it, or if I should rethink that direction.

     

    Managing a chronic illness is teamwork. I need to do my own homework to know what works, I need to be aware when something isn’t working for me (like my pump experience) and I need to be flexible, because things always change. And my endo realizes she is my guide, but this is my journey.

    But in the last six months, I seem to have run into what appears to be the broken health care system that grabs good doctors and sucks them into the conveyor belt of "hospital-managed health care."  While doctors complain that the plight of most patients is non-compliance, I think there is a larger disconnect contributing to that factor and here’s where it starts:

     

    My appointment six months ago went as usual...

    • Blood work: micro albumin, comprehensive metabolic panel, and glycated hemoglobin
    • Office blood glucose check
    • Dexcom download to assess adjustment in management

    At the time of my arrival, they took my Dexcom to download it. I went over the blood work with my endocrinologist while we waited for the Dexcom to download.  After my 11-minute appointment with the doctor was over, they asked that I wait in the waiting room for her to review my Dexcom info. While I waited. I tried to book another appointment, but no one was there at the counter. My doctor reviewed the Dexcom information and said everything looked good, to keep up the good work.

  •  

    Behind all of this were several breakdowns. My A1c had risen since the last visit, so she shouldn't have said “keep up the good work.” She should have analyzed and asked about the highs and lows. So, I went home and looked over the data myself. My lows were too low during the night, so I adjusted my insulin by one unit. My highs were between 4-8 pm, so I made adjustments for my dinner bolus. There also should have been two new scripts for different insulin pens (half unit junior pens to give me more flexilibty and a refill for Synthyroid), and neither of those were called in. A day or two later, I called their office and asked where the scripts were, and they called about an hour later and said they had been faxed over.

     

    The most astonishing piece was when I got my bill in March for that December visit. After insurance, I was asked to pay $136.97 for services.  My out of pocket is usually a $10 co-pay and a few cents might be added for a test.

    What was the change? A new charge for downloading my Dexcom at $68, for which my insurance will cover $13. I was supposed to pay the rest. Furthermore, it was deceptively labeled on the bill as “Continuous Glucose M.” They had also billed me for the balance of the office visit which is not supposed to happen since the insurance company has an agreement with the doctor for the cost of the visit.

     

    The saga continues...

     

    When I called the office to speak to the billing department about this new charge, I asked, “So the download is $68?” Answer: “Yes.”  Then I asked, “If I download the Dexcom myself, is there a charge?”  Answer: “Yes, because she has to read the data.”  READ THE DATA?  Isn’t that the reason I am seeing her?  

    I was really having a hard time getting my head around this. I am charged a fee for an office visit, for which her job is to work with me on my diabetes management. Now, I have to pay an additional $68 for her "evaluation" of my data (which I still had to do myself at home)?  So I asked one more question: "If I bring in hand written records of my blood sugar readings from my meter, will she charge?” Answer: “No.”  I didn’t even know where to go with that, so I ended the call.

     

    I felt stupified. I had to be missing something, because this just didn’t make sense!  If doctors are supposed to be our advocates, then how do you justify charging for what will result in better self-management? Furthermore, this office is not being forward-thinking in care of their patients by saying the "cheap," or preferred method is to use a log book and pencil!

     

    On round two, I got a new nurse practitioner that wasn’t prepared for my line of questions.  She tried to tell me that the charge for reading a Dexcom is “just like a radiologist reading an x-ray. Radiologists charge for reading the x-ray.”  Yes, but they don’t charge for an office visit to read the x-ray!  I then asked, “So what’s the office visit charge covering?”  She just went back to explaining, “It’s like a radiologist…” I listened to her make the sales pitch three times and I felt sorry for her because she was just doing her job.

  •  

    Has anyone else had a similar experience?