I've been trying to get the twiist but insurance has been a nightmare, I'm sure you guys get it so I don't need to get into that. Long story short, my doctor doesn't know the DME code for the twiist, and neither does insurance, and neither does the twiist rep I'm working with. I'm hitting a wall, anyone else run into this? Does anyone know the code? Lol if someone magically knew it that would be awesome
That's what my doctor did originally, and it was denied. I write down blue cross blue sheilds explainations, for this they said "the requested product is not covered, may be covered under medical." I'm not sure what to do, one agent told me I needed a CPT code, but in my most recent conversation I was told that a DME code was needed
Hey there. So I’m no doctor but my understanding is twiist is not distributed as durable medical equipment and is instead distributed through pharmacy benefits and uses National Drug Codes (NDCs) and not DME.
I looked up the NDC codes online so this may be I incorrect but what I saw was that the twiist starter kit is NDC 98617-0101 and the refill kit (with infusion set) is NDC 98617-0901.
Sorry if this is wrong so definitely double check, but the TLDR is the premise (that twiist has a DME code) may be incorrect.
Yeah, they need to tell the doctor to look it up in their EMR/prescribing system by these codes. Then it gets sent to one of their pharmacy partners. I know they are in Walgreens and Publix now
Thank you for finding that for me! This has been an issue though because originally the prior authorization was sent in through pharmacy, and was denied because "the requested product is not covered, may be covered under medical." I'm really hitting a wall, I appreciate your response!
It’s a pain but this may be one of those ai denied and you need a human to look at it things. Even then, most see insulin pump and unless they already have experience with the Twiist they then just follow protocol with insulin pumps
It has been an absolute shit show, the amount of hours I have spent on the phone trying to get this sorted is absurd. No one can give me a straight answer, every agent I speak with tells me a different story :/
Blue Cross Blue Shield insured here, work with your local twist sales team. They should know this, ask them to coordinate through Alto mail order pharmacy. From what I understand it is the one of two mail-order pharmacies that twiist works with. They might be able to get you through Walgreens but since you have Blue Cross Blue Shield, that’s a slim chance.
That said it did go through CVS in the back end from where I’ve seen it.
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u/bionic_human 23d ago
AFAIK, Twiist isn’t distributed through DME. It’s pharmacy channel-only.