Anyone face this medicare issue before?

Last year under the Medicare plan I had (Parts A and B and a Cigna supplemental plan), I got my new Tslim X2 from one of their approved suppliers, Reliable Diabetes. In January I switched to a Connecticare Choice plan. Yesterday I got a notice from CTcare saying they’re denying my claim for the pump. I wrongly thought the pump was purchased and paid for last year. In fact, under Medicare, pumps are considered rented (at $395.45/mo). Reliable is not a CTcare approved provider, so. no coverage.
I called Reliable and spoke to someone in their Medicare insurance dept. He said they’re aware of the claim denial and are trying to get a continuity of care waiver, so CTcare will pay them for the pump. I asked why not try to become an approved provider; he said “oh, we can’t do that.” “Why” I asked. “It could take years” he answered.
Anyone face this before? What was the result?
Thanks, Mike

I’ve wanted a pump for sometime now and the new Mobi pump would be great. I’ve want to micro dose to stop the up and downs of Bolus and basel doseing . I round out that Medicare would not approve me because my epeptide level is to high. Make to much of my own insulin.

I have struggled with insurance companies for years. Right now I am having trouble even getting my regular Humalog insulin that is supposed to be charged to Part B Medicare for my Omnipod Pump. Trouble is my pump has to be charged to part D, part B cannot seem to realize this and approve my insulin. Always battling something, :stuck_out_tongue_closed_eyes:

I don’t have any suggestions of direct knowledge of acquiring a pump under Medicare as the original poster asks. I do, however, know that insulin covered under Medicare Part B is due to its use in a pump that is covered under Durable Medical Equipment or DME.

Unfortunately for Omnipod users including @Terri2, Medicare does not consider Omnipod as DME and only covers it under the Part D Rx insurance. This is a long standing inequity in Medicare policy but Omnipod users may switch to a DME pump to gain coverage of insulin under Part B. Medicare Advantage coverage may differ and is definitely not worth giving up traditional Medicare with supplement plan.

I watched as this happened (about 10 years ago) and think that Insulet (Omnipod manufacturer) could have been more aggressive in its position at the time but reasoned that getting clear coverage under the Part D pharmacy benefit would be the best resolution for the most people.

Prior to that, if my memory is correct, Omnipod was not covered under any Medicare policy. People had been forced to give up the O’Pod (if they wanted Medicare to cover the Pods) as they aged in to Medicare, a really irritating situation.

I have been getting my pump under part D and my insulin under part B for years. Unfortunately, it’s a big hassle every time. If the doctor can pull the right strings and confirm that the insulin is only being used with your pump it goes through.

I’m happy it’s working for you. Just understand that your circumstance is not likely representative of the larger group. May it continue!

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