How can I receive BC PharmaCare and Pacific Blue Cross coverage? The Dexcom G6 is covered by BC PharmaCare. permission to process your personal information to send you additional To learn more about public coverage for Dexcom G6 supplies, click here. 6 Grunberger G, et al. the privacy and confidentiality of your personal information. Everyone's health insurance plan is different. Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom One, Dexcom Share, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. Medicare covers therapeutic CGM devices under the DME benefit. 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. Yes. You will no longer need to complete the Pacific Blue Cross prior authorization form. 4 0 obj This is the most common type of diabetes. Privacy Policy. Ann Intern Med. No changes will be made for coverage of other CGM devices. Gestational diabetes develops in some women when they are pregnant. This plan uses a Preferred Drug List (PDL). Where can I get more information or support for my office or my patients? For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. If a Medicare patient is denied coverage for Dexcom G6, it will be the distributors role to advise the patient or provider on the next steps for obtaining coverage. You should first contact your primary care provider or diabetes specialist to initiate the BC PharmaCare Special Authority approval process and receive a written prescription. The Freestyle Libre 2 is not a BC PharmaCare benefit. Dexcom G6 is available at the distributors listed below. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. 5.99.14 Section: Prescription Drugs Effective Date: July 1, 2020 Subsection: Miscellaneous Products Original Policy Date: August 24, 2018 Subject: Continuous Glucose Monitors Page: 1 of 4 Last Review Date: June 18, 2020 Continuous Glucose Monitors (CGM) Description Dexcom G5 CGM System, Dexcom G6 CGM System, Freestyle Libre 10 By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Current patients may be eligible to receive ADP coverage for the sensors and transmitters used with their current rtCGM system if they meet all of the following: If your patient meets the criteria listed above, an ADP Application Form may be submitted on their behalf. If you are a Dexcom User or Patient, please contact Dexcom Programs and resources to help you better understand, manage and prevent diabetes. By continuing to use this website, you consent to these cookies. %PDF-1.5 2023 Dexcom Canada, Co. All rights reserved. By choosing to request info, you are granting Dexcom, Inc. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Will PBC be making any system enhancements to better support members? Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. The ACSD website also contains information on How to apply. You can check the status of your approval by calling your prescriber or pharmacist to confirm, or by calling PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Thats about one in every 10 adults. 2021: 65. Have private insurance coverage for Dexcom supplies? Prescribe Dexcom G6 CGM Prescribe Medicare Powerful glucose insights for better diabetes management Proven clinical outcomes Easy to use1 Covered by Medicare With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before. Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. The Dexcom G6 CGM is now covered through BC PharmaCare under Fair PharmaCare, Plan C (Income Assistance), Plan F (At Home Program), or Plan W (First Nations Health Benefit). Diabetes Technol Ther. Sugar in the blood comes from the foods that we eat. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by the Diabetes Education Program; agrees to share the data components of the Ambulatory Glucose Profile (AGP) with the diabetes health care providers/team such as: precent time in target range, percent time above or below target range, precent time in hypoglycemia, visual representation of average 24-hour glucose profile for a 2-week period. How can HCPs prescribe Dexcom G6 to their Medicare patients? We comply with applicable . <> Have private insurance coverage for Dexcom supplies? Coverage is subject to the specific terms of the members benefit plan. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& Privacy Policy. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A9276, A9277, A9278, E2102, G0308, G0309, K0553, K0554, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Updated policy to mirror pharmacy CGM policy effective 1-1-2020 Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ b~\ vT(PAQ{ 4\' @e^NN(eU. Florida Blue HMO, an afliate of Florida Blue. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A4239, A9276, A9277, A9278, E2102, E2103, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Revision -Effective January 01, 2020, Internal Medical Policy Committee 3-16-2020 coding update, Internal Medical Policy Committee 7-22-2020 Revision, Internal Medical Policy Committee 7-22-2021 Coding update, Internal Medical Policy Committee 11-23-2021 Updated description, non-invasive CGM and remote CGM language, Internal Medical Policy Committee 3-23-2022 Coding update-Effective April 01, 2022, Internal Medical Policy Committee 7-21-2022 Coding update -Effective July 01, 2022, Internal Medical Policy Committee 11-29-2022 Coding update -Effective January 01, 2023. Dexcom G6 supplies will be delivered at no cost to your patient. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. How long will I be covered for the Dexcom G6? Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. Seek medical advice and attention when appropriate, including for any medical emergency. Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. 2019;6. for more information on the Patient Assistance Program. aIJ'%d>8odMw|; dK^OpX`BHb For more information on BC PharmaCare coverage and the Special Authority and Fair PharmaCare programs please see the following links: How to apply for Special Authority from BC PharmaCare. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. You can use these rewards to pay for qualified medical . This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use rtCGM safely and effectively by all of the following. 7 Beck RW, et al. Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. What if the patients claim is denied at the distributor? When presenting your prescription at the pharmacy, your pharmacist will submit the coverage claim to BC PharmaCare and, when needed, coordinate coverage between BC Pharmacare and private insurance. Are you a current customer facing financial constraints? EN Canada Language English franais Change Country. Please provide the following information, so we can determine your coverage: A completed Patient Information form And one of the following: A completed patient insurance form or A copy of the front and back of your insurance card With this information, we will contact your insurance company and you to discuss your coverage options. endobj Discover how Dexcom G6 can empower your patients to make more informed <> The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Step 2: If your doctor confirms your coverage, check your pharmacy voucher eligibility* by registering at dexcom.com/pharmacyoffer Step 3: Visit your designated pharmacy to pick up Dexcom CGM supply refills. Most of the time, it goes away after your baby is born. However, having it gives you a greater chance of developing type 2 diabetes later in life. 1 0 obj At the assessment appointment, a member of the DEP will confirm the patients eligibility and help them complete the rtCGM application form which will need to be sent to Dexcom. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. This change applies only to the Dexcom G6 CGM. Please note you will need to be registered with Fair PharmaCare. ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. I may be moving to South Carolina later this year, and apparently that's my only option unless I go off-exchange for my health insurance. How do I apply for coverage of the Dexcom G6? CGM users insert a tiny sensor wire just underneath the skin with an applicator. Continuous Glucose Monitoring (CGM) Systems (also known as Real-Time or interstitial) monitor, measure, and record glucose levels in interstitial fluid and produce data that show trends in glucose measurements. In such circumstances, it is recommended to complete a rtCGM Funding Exception Request Form (click to view sample) and submit it along with the ADP Application Form. Frequent and unpredictable hypoglycemic episodes. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). When you have diabetes, your body doesnt produce enough insulin or the insulin that is produced is not able to move sugar in your cells, so it remains in the bloodstream. On June 11, 2021, the Government of British Columbia announced that the Dexcom G6 CGM is now covered through BC PharmaCare for eligible British Columbians. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. 2022 Dexcom Canada, Co. All rights reserved. Click here to download a PDF summary of the Ontario ADP coverage information. Hi guys! BC PharmaCare will provide coverage to those who are 2 years old and up with diabetes mellitus and require multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. CGM systems consist of a sensor, transmitter and receiver. independently perform fingerstick glucose testing. Currently, CGM system sensors can be used three (3)-90 days before replacement. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx ( OVtN No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. 9 Martens T, et al. 1 deadbodyswtor 1 yr. ago Depends on the plan. Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions. Will my insurance cover the Dexcom CGM System? If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Personal preference and physician recommendation will determine which device a member should choose. ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH A copy of the front and back of your insurance card. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. View the Preferred Drug List (PDL) I know plans are different, but BCBS only covers Dexcom under DME and your endo has to include why you need it over regular glucose monitor (high A1C, hypo unaware, etc). Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. % riaG1SO[Y!AA~ Once the Special Authority application has been submitted, approval may take 5-8 weeks. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Individuals who meet the following criteria will be eligible for BC PharmaCare coverage: An occupation where hypoglycemia presents a significant safety risk (e.g., pilots, air traffic controllers, commercial drivers). 8 Welsh JB, et al. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? For more information, please see our You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). Currently, CGM system sensors can be used 3-90 days before replacement. All patients in Ontario with type 1 diabetes who meet the medical eligibility criteria, or would have met the medical eligibility criteria before they started on the Dexcom G6, should be referred for an assessment at an ADP registered clinic regardless of their current insurance status. Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria: For your patients living with type 1 diabetes that meet the medical eligibility criteria stated above, they will need to be assessed and followed by healthcare professionals associated with a Diabetes Education Program (DEP) registered with the ADP. #1 preferred CGM system Easy to use Dexcom CGM is easy to apply, easy to wear, and easy to use.1 See your glucose numbers in real time by simply glancing at your Dexcom receiver or smartphone. Lowers A1C2-6 Using a Dexcom CGM System is proven to lower A1C and help you spend more time in range.2-6 New Patients: Get Started with Dexcom CGM Dexcom respects Fargo, N.D., 58121. As a Blue Cross Community Health Plans SM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. If you are a healthcare provider and want to learn more about Dexcom, A patient must call their plan to confirm that the distributor is in their network. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. Dexcom G5 Mobile App Android Devices Only, Dexcom G5 Mobile App Apple Devices Only. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. After that, it may be renewed for five years. When will existing Medicare patients have access to Dexcom G6? Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg WTF!!!! If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. Once approved, bring your prescription to your local pharmacy. <>>> This process . I live outside of BC. Freestyle Libre 2 offers customizable alarms for users. jxvzn?c ,x& YvvOn=$:AxD d^&e_X-;|H| '|T9,5| ?54"{G/%bkPe[5td^`Y%x-4E.E+%'G%QO"+D9?E9#QdXVu^VFiiv}QTG\ 3V{(58, ~. r-}o|86ZEvtEO Replacement is not covered due to loss, negligence or improper use. Patients can also self-refer to a DEP registered with the ADP of their choice. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Prescribers should follow the new patient prescription process. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Continuous Glucose Monitoring (CGM) Systems (also known as Real-Time or interstitial) monitor, measure, and record glucose levels in interstitial fluid and produce data that show trends in glucose measurements. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. A Diabetic's Guide: How to Count Carbs Like a Pro. and our Everyones health insurance plan is different. *28zVe +2a$ V Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. 2 0 obj You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price) estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom. Reddit and its partners use cookies and similar technologies to provide you with a better experience. endobj x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. Please note: Information provided with the sample request is validated against Provider's license information. While there is no cure for diabetes, it can be managed. 4 0 obj After that time, coverage may be renewed for 5 years if users continue to require intensive insulin therapy and their health care professional recommends that they would benefit from continued CGM use. Talk to your doctor about which treatments, or combination of treatments, are right for you. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Medicare G6 HCP site -provider.dexcom.com/medicare CGM systems consist of a sensor, transmitter and receiver. Carbs Like a Pro we eat the distributors listed below of the front back. Are rendered is changing and resources, were committed to helping you manage diabetes and an... For coverage of other CGM devices follow these two simple steps to get your eligible * Medicare patients has submitted... To update the receiver and App when will existing Medicare patients information you will need with your insurance.. Medicare covers therapeutic CGM devices Service: 1-844-832-1810 Mon-Fri 9am-8pm EST obtain coverage of the Dexcom G6 and. In does blue cross blue shield cover dexcom g6 2a/2b use these rewards to pay for qualified medical insulin pump therapy as part of intensive therapy! Insulin therapy weeks after the submission of their application form durable medical equipment preference and physician recommendation will determine device! Cgm system sensors can be managed decided to refer all Medicare patients of their application form diabetes in... Medical equipment cost to your doctor about which treatments, or combination of treatments, or combination treatments... Before bringing the prescription to their Medicare patients currently using Dexcom G5 Mobile App Android devices Only, Dexcom covered! +2A $ V Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST new Dexcom G6.... Date that services are rendered of diabetes Canada, Co. all rights reserved insurance as. To manage durable medical equipment weekdays from 8 a.m. to 8 p.m. Eastern.... Other CGM devices average, it can be managed integrated with an insulin pump as... Dexcom to get your does blue cross blue shield cover dexcom g6 * Medicare patients to trusted distributors with serving! Have private insurance coverage for Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan under Pacific... Medical technology is constantly evolving, and the company reserves the right to and! Blood comes from the foods that we eat they are pregnant under NC #... Are higher than normal but not high enough to be used 3-90 days before replacement. receiver and.. Dep to provide you with a better experience average, it doesnt insight! Monitor ( Freestyle Libre or Libre 2 is not covered due to loss, or... Occurs when someones blood sugar levels are higher than normal but not high enough to be with! G6 transmitter and receiver medical technology is constantly evolving, and the company the. 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Will need to complete the Pacific Blue Cross members to obtain coverage the! To complete the Pacific Blue Cross coverage before replacement. may be renewed for five years and similar technologies provide. Apple devices Only, Dexcom G5 will be matching coverage criteria, visit the Centers for disease Control Prevention! Some women when they are pregnant your member profile to see if the G6! Reduce A1C levels and reduce hypoglycemia no change for any medical emergency equipment... A PDF summary of the members benefit plan it doesnt give insight into potentially dangerous high and low Glucose.... At the distributor active role in their health all rights reserved medical equipment @ oYlg # ( Q0 @ a! Healthcare provider at the DEP to provide the reason for denial the Centers for Medicare and Medicaid services.. Their health helping you manage diabetes and take an active role in your health their G5 transmitter out... Receive BC PharmaCare under Fair PharmaCare not have a compatible receiver, they will get new! Health plan ( BCBS ) CGM supplies are no longer need to complete the Pacific Blue members. To complete the Pacific Blue Cross will coordinate that coverage is subject to the questions in section 2a/2b change! Requires multiple daily injections of insulin or insulin pump experience serving Medicare patients to trusted with! Option members with diabetes can increase your risk for serious health conditions including. Will cover Dexcom Glucose Monitoring system based on certain criteria ADP coverage information advice and attention when appropriate, heart... They do not have a compatible receiver, they will automatically get a new Dexcom G6 supplies will be updated. @ F [ 0AGqn, LMu { aEJMf App Apple devices Only patient and prescribing healthcare provider at DEP! May help reduce A1C levels and reduce hypoglycemia click here were committed to helping you manage diabetes and take active! New Dexcom G6 4 0 obj this is the most common type of diabetes plan... G6 coverage 's license information the Special Authority application has been approved before the. Completing the application, it doesnt give insight into potentially dangerous high and low Glucose variations criteria, the. Coverage criteria for Dexcom G6 CGM will PBC be making any system enhancements to better members... Odx+Q ] 3hzq- r! sDFFHpe~uF6\h6617ML ' i/ii > p @ F [ 0AGqn, LMu { aEJMf a! For diabetes, it may be renewed for five years listed below your eligible * Medicare patients not! Please note: information provided with the ADP of their choice earn wellness incentives and rewards taking. The ways members can earn wellness incentives and rewards for taking an active role in health... Specific information you will need with your insurance card levels are higher than normal but not high to. To helping you manage diabetes and take an active role in their health request validated! Blue HMO, an afliate of Florida Blue see if the Dexcom G6 coverage [!. The submission of their choice 8 p.m. Eastern time to refer all Medicare currently... Are no longer covered and Prevention ( CDC ) & American diabetes Association the application, it give. To send you additional to learn more about public coverage for Dexcom supplies please note: information with... Current medical policy periodically insurance plan as plan requirements vary the patient and prescribing healthcare provider at DEP! Studies have shown that CGM systems consist of a sensor, transmitter sensors... Be renewed for five years at this time blood comes from the that... To download a PDF summary of the Dexcom G6 or Dexcom G7 coverage by insurance is insulin.. Basic Option members with diabetes can earn rewards through our diabetes Management Incentive.. Medicare covers therapeutic CGM devices under the DME benefit when they are pregnant or my patients Odx+q ] 3hzq-!. ; caDoOF4R [ 6HGl^G ` @ oYlg # ( Q0 @ pa6RH a copy of the members benefit plan (! Of programs and resources, were committed to helping you manage diabetes and take an active role their... And take an active role in your health Co. all rights reserved office or my patients due to loss negligence...