Medicare & pumps
Hi, I’m new to this list but I have a question that maybe someone can
answer. My diabetologist feels that I should go back on the pump. I’ll
be on Medicare in January and according to the November issue of
Diabetes Forecast, Medicare will cover an insulin pump but it’s
necessary to have a C-peptide less than 0.5 (I had a C-peptide done but
if I’m taking insulin regularly will it be that low?) Also the person
has to take at least 3 injections a day and making dose adjustments for
at least 6 months. I’ve been doing that since August 1. The person
checks blood glucose at least four times a day and keeps records proving
it. (that seems to be a given–I check regularly and I can’t imagine
being on a pump at the present time without doing so). The final quote
is the problem unless there are some "or’s" omitted. "The person has an
HbA1c over 7 percent, a history of recurring low blood glucose
reactions, wide flucuations in glucose swings and/or dawn Phenomenon ( a
rise in glucose levels in the early morning, often climbing above 200
mg/dl) I have a feeling my HbA1c will be under 7 percent. On the
one-touch meter I average 150 but that includes levels of 30 and 490
(and I’m really trying) Should I pig out and raise my HbA1c? It’s easy
at Christmas even though my sister has stopped giving me home-made
Christmas cookies.
Thanks,
Mary
August 19th, 2005 at 6:01 pm
Mary,
The rules established by Medicare seem hopelessly bizarre and
unnecessarily restrictive, and probably discourage many potential pump
users from considering the change.
But, I wouldn’t let this stop you from going back on the pump; the
benefits certainly outweigh the hassle implied by this nonsense. It
sounds like that if you qualify for the pump, after you use it for
awhile, you will then lose your qualification, since you will no longer
meet their requirements!
I obtained my pumps (I am on #3 now) from private insurance, but now am
on Medicare. Do you know if they pay for upgrades in any form?
Your averages are similar to mine; I generally have a 30 day moving
average of 130 to 140, and the resulting A1c is 6.9. I test at least
8 times a day, and often more.
David
August 21st, 2005 at 11:30 am
Medicare does not pay for supplies does it?
Gail
August 21st, 2005 at 10:43 pm
Hi Mary
August 22nd, 2005 at 6:51 am
Hi Mary: Joan Here….there are a lot of things to learn about your
insurance coverage and what your insurance company and Medicare are willing
to cover.
I would suggest that you go to www.cdc.gov and thru that to the diabetes
website links. Medicare has a very complicated set of requirements. It
might be a good idea to contact Insulin Infusion Specialists…1800-838-7867
and speak to a Customer Service rep. They are the largest supplier in the US
for all the pumps…Minimed, Disetronic, and Animas.
They can do a precertification; you can get one of the reps to come and show
you all the pumps so that you can learn the features of each, which one you
think you want to work with…the different insulin administration
sets….they can also help your endo with all the necessary
paperwork…..certificate of necessity and all that, which can take a week or
so. They can even provide a trainer so that you learn how to handle the pump
well.
Invest in John Walsh’s book - Pumping Insulin…..it will be an immense help
in answering a lot of the questions you’ll have.
Don’t be afraid to go back on the pump…If you’re asking us questions, it’s
because you’ve been following us on the list so you have a pretty good idea
of how we all feel about pumping. Take a shot (no pun intended -
ouch!)….Joan :))))))
August 22nd, 2005 at 7:10 pm
Gail,
Medicare pays for test strips, but you have to jump through hoops to
qualify. I had my endo provide a statement that confirmed that I use
250 strips per month, and as a result, Medicare pays for them. This
becomes a substantial amount on an annual basis. I wish they would do
the same thing for infusion sets.
David
August 24th, 2005 at 2:10 am
mary,
i think we must have the same employee (diff state maybe ??) adelphia?i
have the pump now
for 8 months.insurance paid all but 250.00 and pay for supplies.i have the
disetronic H tron plus.what state are you in. we are in northern va dc
area.
sharon (interesting who you surf with huh?)i’m curious now.
Hi Mary: Joan Here….there are a lot of things to learn about your
insurance coverage and what your insurance company and Medicare are willing
to cover.
I would suggest that you go to www.cdc.gov and thru that to the diabetes
website links. Medicare has a very complicated set of requirements. It
might be a good idea to contact Insulin Infusion
Specialists…1800-838-7867
and speak to a Customer Service rep. They are the largest supplier in the
US
for all the pumps…Minimed, Disetronic, and Animas.
They can do a precertification; you can get one of the reps to come and
show
you all the pumps so that you can learn the features of each, which one you
think you want to work with…the different insulin administration
sets….they can also help your endo with all the necessary
paperwork…..certificate of necessity and all that, which can take a week
or
so. They can even provide a trainer so that you learn how to handle the
pump
well.
Invest in John Walsh’s book - Pumping Insulin…..it will be an immense
help
in answering a lot of the questions you’ll have.
Don’t be afraid to go back on the pump…If you’re asking us questions,
it’s
because you’ve been following us on the list so you have a pretty good idea
of how we all feel about pumping. Take a shot (no pun intended -
ouch!)….Joan :))))))