Rarely do things actually go as planned when it comes to living with diabetes.
Whether it's ordering test strips or pump supplies, searching for answers from our insurance companies, or just the daily hurdles of trying to finetune carb-counting and insulin dosing -- it's not often things go as smoothly as we hope they might.
Hope for the best, but plan for the worst -- that's the motto I've always kept in mind for the better part of my 30 years with type 1.
Now, it seems we can add Dexcom G4 Transmitter replacements to that list.
If you remember, the new G4 Transmitters are smaller and brainier than the older version, so they only carry a six-month warranty rather than a full year, like the previous Seven Plus models did, and also the G4 Receivers still do. The reason: they have more technology inside and use up more battery life thanks to the improved accuracy and longer distance range they offer between the Transmitter and Receiver. So Dexcom shortened the warranty specifically to assure they would be replaced regularly.
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At the time of initial order, customers are told by either Dexcom or the third-party distributor that they're submitting two Transmitters for insurance "pre-approval" and that it won't be a problem getting that replacement once our initial transmitter batteries poop out. The product's low battery warning is supposed to flash as soon as the battery begins dying, and the user guide says we should have at least a week before it totally drains (depending on how much we use it, from what range, and so on).
But that's not always happening, we're hearing.
Some folks in the Diabetes Community report that their Transmitters aren't showing the warning at all, while others say they only get a day or two out of the Transmitter once the low-battery message flashes on the iPod-esque Receiver screen.
We're also hearing that some Dex users are running into problems obtaining a replacement Transmitter either because of paperwork delays or due to "pre-approvals" not being submitted to insurance companies as they were supposed to be at the time of initial order.
One PWD facing these issues is our own Wil Dubois, who's a longtime type 1 and happens to be the 30th person in the U.S. ever to begin using a CGM when they first appeared on the scene back in 2005. Since then, he hasn't been without his CGM for a day -- until recently when he got only 39 hours out of his Transmitter between warning message and total battery death. Thanks to Dexcom not processing his replacement paperwork correctly, Wil was without his CGM for the first time in almost a decade, and of course this happened just as his family was about to start traveling during his son's Spring Break. Being completely hypo-unaware, Wil found this to be a dangerous and unacceptable situation.
Wil's been writing about the experience on his personal blog, Life After Dx, and he tells us that the problem was simple: someone in the Dexcom ordering department didn't do what they were supposed to time of his initial buy.
"Last summer, I was told the the approval was supposed to cover two Transmitters, but apparently someone checked a wrong box on the form so I was approved for the G4 with only one transmitter," he said. "The Dex folks several times told me not to worry, that when I got the warning there would be 'plenty of time' to get the approval and that it would last for a week or maybe even more. This concerned me, because I had heard rumors otherwise."
Wil says that when Dexcom submitted the replacement Transmitter request to his insurance company more recently, the insurer replied with a statement that they were backed up at least three weeks on "pre-authorizations" so this customer wouldn't receive a replacement before then.
As it turned out, a friend in the DOC -- the great Kelly Close of DiaTribe -- was able to help out where Dexcom couldn't. She had an extra Transmitter on hand and was able to send that to Wil to use until he got his new one from Dexcom. Way to go, DOC!
Sadly, Wil isn't alone in this situation.
We've seen a handful of others in the DOC mention similar circumstances in which their Receiver either didn't give a warning or didn't last as long as a week, and they too pointed to problems getting a replacement quickly because of issues with either Dexcom or a third-party distributor.
Of course we have to remember that not so very long ago, no one had a CGM, so the idea of going a few days or a week without one now shouldn't be so catastrophic for most of us. But for someone like Wil, who's completely unaware of oncoming low blood sugars, it feels like a matter of life or death, to be sure. And the rest of us have simply come to depend on this technology that shows us our blood sugar fluctuations in real-time. For Dexcom as a company, it's almost "a good problem to have" that customers are so fixated on not missing a day with their product.
The point of this post is: 1) to let people know about the issue, in case you're a Dexcom user yourself, and 2) to explore how a medical device company handles this sort of hiccup.
Reaching out to Dexcom for an official response, the company's executive VP of strategy and corporate development Steve Pacelli points out that it's been 18 months since the G4 hit the market, and these reports of Transmitter problems aren't widespread, but effect only small number of isolated examples.
He also says Dexcom has been very clear from the start that these G4 Transmitters only have a six-month warranty and the batteries could go quickly once the warning is displayed. But at the same time Pacelli says many Dex users are reporting that their Transmitters are lasting 10-11 months before any battery warning appears. He hadn't heard about any Transmitters not showing a warning at all, or only lasting a day or two, and said that was something Dexcom would look into.
But I'm still sticking with my mantra of planning ahead in preparation for likely delays and snafus.
Seriously, if I had a dime for every time someone told me there'd be no issue getting supplies or paperwork processed, I'd have enough to meet my yearly deductible many times over. And I'd have countless gaps in my insurance coverage and supply stock, waiting for everything to work out as I was told it would. No, preparing for these delays is just part of the game.
I purchased my Dexcom G4 system back in August, and it's been eight wonderful months without any troubles. The G4 has saved me from scary lows a number of times, and I think it's helped me regain control to help fine-tune my management.
But now, seeing these stories online from Wil and others, I started worrying that I might run into the same problem.
So, I decided to order a new G4 Transmitter up-front, to have it at the ready. A phone call to my third-party distributor Edgepark proved to be a smooth process, but of course I was told they'd have to submit the replacement request to my insurance company for verification.
Apparently, like others, my initial order didn't include any pre-approval for a backup as I was told it would at the time last summer. A day later, I received a call back from Edgepark saying that my insurer had accepted the claim and that I owed a 20% co-payment since my deductible had already been met (thanks to my insulin pump purchase earlier this year!).
This seems to be where others have run into a brick wall, with their insurer denying the claim and refusing to pay after already approving a Transmitter within the past year. Luckily, that issue didn't materialize for me.
The order was placed, and four days after my initial call, my second G4 Transmitter arrived via FedEx. Since I haven't gotten a battery warning yet, I'm leaving it inside the box until that time arrives. When a low battery warning does eventually pop up, I'll hang on a bit just to see how long the Transmitter lasts after that...
I have no doubt that Dexcom is telling the truth about this not being a widespread issue. But again, the point is that when it comes to medical tools that are so critical to people's lives, we always need to "hope for the best and plan for the worst." Just in case.
Because you know what happens if we don't.... a monkey wrench is thrown into the gears of getting our supplies or devices as expected, and that's not cool when our health is on the line.
** UPDATE: My first transmitter gave me the "Low Battery" shout-out on June 1, and lasted about six days with a few more warnings before eventually biting the dust. Glad to have had the backup on hand, but also thankful the warnings came as they were supposed to.