Ever heard the saying, “(wo)Man plans and god laughs?” Got that right!
So I’ve been on the Animas Ping since I started pumping in 2011. When they made their announcement about going out of the pump business I considered going right onto the Medtronic but the very day I was doing my research it was announced that Medicare was approving the G6. Since I had recently started the G5 I would be able to upgrade and then could pair it with the Tandem to achieve the much coveted goal of an AP. Medicare has not approved the Medtronic 670. Those of you not yet at Medicare age may not realize that even if you have great “regular” insurance as I do, Medicare has the final say in what will and don’t be covered. And Medicare is the Mussolini of the insurance world.
I talked to Tandem late last year I think and and since my current pump warranty doesn’t expire until March 2020 I might have to wait until then to get the T-Slim. However, they thought there was a good chance Animas would call it quits for good in September 2019 and void all warranties at which time I could get the Tandem. No worries, I thought. Dexcom was dragging its feet on releasing the G6 to Medicare patients and so I would be able to get used to a CGM altogether with the G5, then get used to the G6 and then move on to the integrated system. I prefer my learning curves one at a time.
When the recent letter arrived offering $750 for returned pumps with a deadline of 9/30 I thought, “Cool!” I will get some extra cash (to go to my SE Asia trip this Christmas!), and then get my T-Slim in September! Right? Wrong!
It turns out Medicare is refusing to let us have a new pump sooner than 5 years so even though my warranty will be voided and I will have no pump, I still have to wait??? Yikes! Tandem is, apparently offering “temporary warranties” for people in this situation for a charge of $1,000 which just pissed me off as they are looking to make money on our hardship! A call to an actual Supervisor revealed that this offer doesn’t apply to people on Medicare! He offered to have me do a three-way call with their provider and Medicare to assure me Medicare wouldn’t allow a new pump, but told me he had spoken to literally thousands in the same situation so I didn’t bother. I figured I’d have no choice but to go on the Medtronic temporarily as no way can I make supplies last that long. However…long story does have an ok ending…I spoke to the supplier (CCS 800-599-7521) and they said they had a limited amount of Ping supplies they could sell me and that after those ran out there are compatible cartridges and infusion sets. So it sounds like I can wait out my warranty and go straight to the T-Slim. I decided not to take advantage of the $750, even though I have an older Ping I can use because I’m paranoid it will void my warranty and I won’t be able to get supplies (probably won’t happen, but I’d hate to shoot myself in the foot).
Why did I write this long boring tale? In case any of you are in a similar position and the info is useful mainly. Also to vent. In case I’m missing something you may know though it sounds like this is the only option.
So many people have been stressed out by Animas’ decision to leave the pump market. When I first joined this site Animas and Medtronic were the pumps of the day and Animas was giving Medtronic a run for its money.
Animus was the innovator of the time, it was so sad to see them bow out of the market. I think you will like the Tandem pump. I have a Tandem but not the X2, it does not integrate with a CGM but still I like it.
@Zoe - I find myself in a similar situation in Canada.
Our provinces (same as states) usually fund pumps for T1’s. My province used to have 3 approved pump choices: Animas, Dexcom and Omnipod. Of course now there are 2
Issue for me is once Medtronic cuts off their Animas supplies in September I’ll still have 3 months left on my warranty. I don’t want a Medtronic pump. I want a Tandem (approved federally but not provincially).
Unless I take Medtronic up on their offer, I’ll have no pump supplies. I don’t want either a Medtronic or Omnipod asI’d be stuck with it for the following 4 years.
Sorry you’re in a similar jam, Jim. Is there possibly another supplier in your province like the one I found here that will be able to provide you either Animas supplies or other compatible ones after September? Perhaps you could ask Tandem as I did what suppliers they use. I also have a friend who has switched and offered me leftover Animas supplies to get me through until my warranty is up.
That’s expensive! Won’t your usual insurance cover it? I wouldn’t think Animas’ situation would preclude coverage of supplies as long as you don’t double order them from different places. But I don’t pretend to understand my own insurance let alone anyone else’s! Hopefully one way or another we will both make it through until we can get a new pump.
Pump and supplies coverage is a lot different here in Canada. I don’t have a private (work) insurance plan, so my pump coverage is strictly run on a provincial (regional) basis.
Getting thru to them for something they already believe is covered would be problematic (they’d likely say just switch to Medtronic system and we’ll maintain coverage).
Zoe - I was under the impression that the Tandem pump would be covered. My Animas Vibe 5 year date with Medicare is Oct. 2020 but I sent it back in Sept. 2019 (for the $750) and between Tandem and Solara Medical they said I was eligible for a new Tandem pump. Yesterday I received a letter from Medicare that was a copy of what they sent to Solara Medical saying their appeal to have my pump paid for was denied. I’m 71, had T1D for 66 years, several diabetes related complications (heart, kidney, stomach), live in AZ (high COVID-19 infections), just had my SS# used fraudulently, and now find out I will have to pay for this pump. I live with my daughter (substitute teacher), special needs granddaughter, and my 9 and 13 year old grandkids. It beyond anything I can manage right now. I did some research on this at the time and really thought that when the company went out of business it would be possible to get another pump.
Shirley B, diagnosed T1D age 5, 1954
I’m so sorry you’ve been through all that, Shirley. We are exactly the same age, though you have been diagnosed for MUCH longer than me. I keep having the idea that our lives are supposed to be easier at this stage! Silly me.
I can’t, of course, speak for Medicare, and their response to you seems pretty lacking in explanations, but to me, since I have gone through the same thing, it seems to me that you need to wait until October, 2020 until your 5 year Medicare pump date is up. I thought too, that since Animas was out of business I should have qualified for a pump sooner, but I had to wait until this past March when my own five year date was up. (I made due with the Medtronic for the interim and added in the Dexcom as soon as it was approved, so I pretty much took small steps to get to my goal of being on the looped Tandem system…which was worth waiting for! What have you been using since you returned your Animas? Can you remain on that until October when your Tandem should be covered by Medicare?
Zoe
Between Tandem and Solara Medical Supplies I was sent the Tandem t:slim x2 in Nov. 2019. So I have the new pump and at the time thought Medicare had approved it being paid for. The letter I just received was the first time I had any idea that the pump wasn’t covered. I look at MyMedicare for what claims have been paid but guess I didn’t pay enough attention to realize what was going on. I assume I will soon receive an invoice from Solara Medical asking for the full payment price for my Tandem t:slim pump. I know they won’t take it back and quite honestly don’t know what I’m going to do. I’ve survived 3 heart attacks, 5 bypass surgery, stage 3b kidney disease (plus ANCA vasculitis), have gastroparesis. I just keep thinking there should have been a pre-approval or someone that knew this wouldn’t work. When I sent my Vibe back last Sept. I used my old Animas Ping (it still worked but had a pink screen I could hardly read!). My concern is I have no clue how I’m going to pay for a $7000 +/- pump and the supplies if they charge me for those too.
Yikes! That doesn’t even make sense to me - though why I expect Medicare to make sense I don’t know. Why would they give you a pump in November 2019, with no billing mechanism and then wait until now to say, “oh by the way…??” I would assume they would have told you that you didn’t yet qualify for a new Medicare pump and asked you right away to pay out of pocket! I’m far from an insurance expert but I would suggest finding someone who IS because that just doesn’t sound kosher to me. I assume there is no help you can receive from your supplemental insurance? I would seek out a Medicare lawyer or advocate of some kind to pursue a loophole based on them not informing you of your lack of coverage until 8 months later. Worse comes to worst I would think you could just make them take it back as you can’t pay for it. Then I still have my Medtronic and would be more than willing to send it to you. I also have a Dexcom I no longer use now that I’m on the Tandem. Even if you had to pay for Medtronic supplies it would still be better (I’m sure someone has Medtronic supplies left over they can give you.) Those are all my thoughts. I’m angry on your behalf. That is crazy that they would do that to you! (on the part of both Tandem and Medicare.) I hope other people on here who are more insurance/Medicare savvy might have some suggestions. Yikes!
I know. I usually try to keep phone notes when I talk to someone so hope there is something I can at least refer to for who I talked to last Oct. I figure if I have to pay for it I might try a GoFundMe request. Never thought I would have to do that but in the midst of what is going on I can’t cover the cost. Tomorrow I’ll start making calls and try to figure out what my options are. I did just look at MyMedicare claims and it does show the claims weren’t covered. Solara often seemed to be re-sending the supply claims so i just saw the occasional non payment as part of the supply claims. It just doesn’t make sense that they didn’t let me know after the first claim was denied. Thanks for letting me vent about this. Long story, but in 2015 I had Influenza A (vaccine didn’t cover that strain). The virus most probably caused the ANCA vasculitis so to save my kidneys I went on chemo and very high dose steroids for 9 months. Four months after I stopped, the femoral neck bone cracked in my leg leg due to the chemo/steroid drugs that caused bone necrosis. I couldn’t get the hip fixed because of my heart and didn’t want to be in a wheelchair so I figured out how to walk with it. Lost 1.5 inches of leg but I can get around. My health issues I can survive - it’s the insurance, etc. part that’s really taking a toll. Thanks again -
I agree. Bureaucracy is crazy stressful. But you sound to me like an amazing survivor, so hopefully you will find your way through this maze. I hope you find someone or several someones who can provide you insight on how to navigate all this without being penalized by the system. Go Fund me is certainly an option and I know the diabetes community is very supportive. But let’s hope you get some fair response from Medicare with a bit of help!
Maybe Solara is incorrectly sending the claim to medicare instead of Tandem. There is no way you should be liable for $7,000 when you took Tandem’s offer to upgrade from your defunct Animas pump. You are definitely going to be calling a slew of people but you should be able to resolve this satisfactorily. Keep track of everyone you talk to and if you do get a resolution try and get it in writing so this doesn’t come back later.
Thanks! I appreciate the input. It would have been better had I done the offer directly with Tandem but I did it through Solara and they sent the pump. / Shirley
