have had my pump for about a year now and visiting my Endo every 3 months is getting old and useless. All she does is take my progress reports and check my AIC. I use the Dexcom G4 so I tell her what my AIC is before she gets the finger stick results. I don’t know about others, but these visits for me are a complete waste of time and money for everyone. My question is does anyone no a way{s}, other than throwing my pump in the trash and go back to insulin pen, to get a wavier from Medicare or to modify this requirement? I don’t know about you guys, but at my first visit after I started using my T-Slim I gave my doctor and her staff and training course on how to use it, lol.
Is there a way you can reduce your visits to say twice a year? Somehow i always seem to have things to discuss with my endo, so it never gets old… What was different when you were on MDI?
I have a note folder on my iphone where i have my questions for the dr, so i have them ready for when i see him.
I am trying to do something similar in the way of collecting questions in a list so I will remember to bring them up when I visit.
And while the MDs & I never really collaborate too much on how I use my pump, it still gives me a chance to get prescriptions refilled. My VA doctors seem to actually prefer to see you in 3D rather than just remotely renew a script.
The other main reason I don’t mind the 3 month visits is so someone can independently check my vitals. Always nice to have some who is supposedly objective give me assurance that I’m still alive.
You know, in hindsight, given the demand on resources at the VA the trick there is actually getting seen every three months. It’s more likely to be at least 4 to 6 months before they have room in their schedule.
I’m not sure how rigid this requirement really is. I know 3-month visits are standard where I am, but I’ve been on bi-annual for years. I recently switched to a new insurance provider and hence a new endo, who originally had me down for the 3-month interval, but after seeing me for the second time and seeing how good my control is she asked if I felt like I needed to come that often and we agreed biannual was fine. I expect it’s something you can discuss with your endo and change if you both agree you’re doing ok BG-wise.
I believe the three-month visit for pump users is a Medicare requirement. I remember not so long ago when @shoshana27 had trouble getting her supplies ordered because she missed an appointment with her endo due to illness, and Medicare, therefore, refused her supplies order.
Let me say thanks to all of you who have responded to my post. You all shared good reasons why going to you r doctor every 3 months may have merit, but none apply to me. I am like DrBB in that at this time in my diabetic life once a year would be to many and this was what my Endo had me doing before the pump. This is a matter of Medicare requiring this many visits per year for excellent controlled diabetics. In me case it is simply a waste of my now $40 co-pay per visit and time. My Endo agree that I have no need to be there other then getting a A1C somewhere every 3 months, but she is just complying with Medicare’s guidelines. However, based on my Dexcom G4 Clarity A1C report I don’t even need to do that. My Clarity A1C and my in office A1C have matched for the past year, 5.2% each time. I just need Medicare to stay out of my health care needs and let my doctors do their jobs. Better still Medicare needs to come out of the dark ages about a lot of things. Would anyone like to buy a good T-Slim pump, cheap.
Hi Bob,
Just an FYI, it is actually not legal to sell your insulin pump, certainly not on TuD - I can point you to the rule for that
I can find no real “requirement” in Medicare that you must have your A1c tested every three months. In fact, Medicare offers coverage for 2 tests but does not “require” them. Your doctor should show you this guideline so that you can share it with us!
Some practices and some insurance may have their own requirements, I had a pcp once who suggested that I had to get my A1c tested to get my insulin RX…claiming it was the law. I fired that practice.
I get my A1c and all labs done once a year with a check up for my entire body and conditions. The only time I go back is if I am sick (and I mean dying), or broke something. One physical a year is covered but there is no “requirement” that I must have the physical. Admittedly the doc wants to see me to make sure my RX’s don’t need to change and are met according to my condition labs.
Diabetics seem to also ride on dark age rules, regulations, and requirements many that don’t even exist anymore or even ever. When an r-word is claimed before I can get what I need to get out and get to work I ask for the proof. I also let my providers know that my coverages don’t comply with their claim so if I am “required” to get a blood draw every three months I am not going to pay for it.
Can someone please show this requirement from Medicare? I see it presented all the time but have never been able to find it.
My system works like this… I never make an appointment before leaving the doctor’s office. When it’s time to get lab work, I email my endo’s office and ask them to put a request into the lab. I only go to the doctor in real time when I have a reason that makes sense to me.
Hey Karen didn’t mean to alarm you. My comment about selling my pump was a little funny. Also, my comment about my Endo complying with Medicare’s guideline related to the 3 month visits, which is a Medicare requirement. Sorry for the confusion.
[quote=“Bob_Martin, post:13, topic:50963, full:true”]
Hey Karen didn’t mean to alarm you. My comment about selling my pump was a little funny. Also, my comment about my Endo complying with Medicare’s guideline related to the 3 month visits, which is a Medicare requirement. Sorry for the confusion.
Bob
[/quote]No problem, Bob. But that "Endo complying with Medicare’s guideline related to the 3 month visits, which is a Medicare requirement. " is the thing that is impossible to find in the Medicare information and coverage rules for diabetes. I keep asking for the “guideline” and folks keep telling us there is one but no one will offer up where exactly (either on line or in the publications) that guideline exists. I thought you could ask your Endo for a copy of it.
Cut and pasted from Laddie’s link above. See the bold text near the bottom of this block:
e. Continuous Subcutaneous Insulin Infusion (CSII) Pumps (Effective for Services Performed On or after December 17, 2004)
Continuous subcutaneous insulin infusion (CSII) and related drugs/supplies are covered as medically reasonable and necessary in the home setting for the treatment of diabetic patients who: (1) either meet the updated fasting C-Peptide testing requirement, or, are beta cell autoantibody positive; and, (2) satisfy the remaining criteria for insulin pump therapy as described below. Patients must meet either Criterion A or B as follows:
Criterion A: The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin doses for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen:
• Glycosylated hemoglobin level (HbAlc) >7.0%;
• History of recurring hypoglycemia;
• Wide fluctuations in blood glucose before mealtime;
• Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl; or,
• History of severe glycemic excursions.
Criterion B: The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment.
General CSII Criteria
In addition to meeting Criterion A or B above, the following general requirements must be met:
The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement, or, as an alternative, must be beta cell autoantibody positive.
Updated fasting C-peptide testing requirement:
• Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110% of the lower limit of normal of the laboratory’s measurement method.
• For patients with renal insufficiency and creatinine clearance (actual or calculated from age, gender, weight, and serum creatinine) ≤50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200% of the lower limit of normal of the laboratory’s measurement method.
• Fasting C-peptide levels will only be considered valid with a concurrently obtained fasting glucose ≤225 mg/dL.
• Levels only need to be documented once in the medical records.
Continued coverage of the insulin pump would require that the patient be seen and evaluated by the treating physician at least every 3 months.
The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII.
Emphasis is mine.
Medicare pays for my pump supplies under Part B since I use an insulin pump. Every three months the supplier calls me to see if I’m ready for another three month supply. They will not ship unless I give them a doctor visit date within the last three months. They appear to be working under this rule.
BOOM, there it is!! Thanks Laddie, and Terry. Now I can stop searching for it. Makes me SMH, I am glad I am not on Medicare, I can’t afford an A1c test every three months in time or money
My doc has offered to reduce the frequency of my visits to 4 or even 6 months but I just prefer seeing her more often, just in case, like voodoo or something…
I only see my endo every 6 months, but when I get to Medicare in 2017, I will save the tax payers money by seeing her twice as often…
Actually my endo has hinted that there are ways around this requirement. Not sure if that just means seeing another doctor (like my internist or eye doc) or whether it might be seeing a CDE instead.
From what I have read (lots of discussion in the IPF on this requirement), the necessary supplies to use the pump are not covered. I think I would just buy them but YIKES! For sure it would be less expensive to just go get the unnecessary 3 month requirement met. I hope this requirement changes, it kind of looks like Medicrap does not like insulin pumps so much.
