I saw a post a few years ago from someone who was T2 who said that Medicare would not pay for a pump because they were T2…good that things have changed.
Ok, thanks, Moss, that makes more sense.
Another part to this is if you are positive for autoantibodies it makes no difference whatsoever what your c-peptide is you are covered.
That is crazy that he argued with you about it. I don’t blame you for wanting it done then.
If you read the requirements on the CMS site, you have to meet the c-peptide requirements - it is not an either or thing and states they must be met.
If you look one sentence before what you cut and pasted above you will see:
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.
You are right Mossdog! Sorry, I did not see the “or” - I have always heard it had to be the c-peptide regardless of anything else. Sorry abou that@
Actually, the problem is that the guidelines are written biased for a type 1. A type 2 who may be severely insulin resistant may have “relatively” almost no beta cell function left, but the same “absolute” guidelines are applied. To be consistent the guidelines should scale the c-peptide levels, if you can’t eat a 15 g carb meal without going over 200 mg/dl at 2 hrs then you are insulin deficient. Yet the c-peptide levels are scaled for a person with normal insulin resistance, not for a person with insulin resistance.
I have some insulin resistance. I would be seriously challenged to qualify for a pump, let alone a CGMS with the current system.
Unfortunately there is still yet to be ANY guidelines from Medicare to get a CGMS. My personal opinion on this is Medicare should decide whether or not they cover something and the rest should be up to the prescribing Doctor and the Patient.
Not saying anything about your particualr situation but I know quite a few Type 2’s on Medicare who were able to get a pump.
In my opinion, we should not be letting Medicare establish medical guidelines. What medicare decides establishes what insurance covers and that becomes the defacto medical guideline. It is a sad state of affairs.
Synthetic insulin does not have C-peptides so it is fine to take the test while using insulin. I wouldn’t worry because if you were already on the pump your c-peptide reading was negligible at best when you got it.
@bsc I agree.
But why is it the defacto medical guidance? How can we stop the other insurance companies from following?
Although generally I agree, in my area the Type 2’s that have private insurance for the most part do not have to submit to a c-peptide to get coverage on a pump.
I got a call from my Dr. office last week and my c peptide was less than 0.1, so I think I’m good.
I got a call a few days ago and my supplies are being sent this week. I feel much better : )
Congratulations, Mary Anne! I would expect this to be a one-time activity, so hopefully you’ll be all set from now on.
I am still waiting for Medicare approval of pump supplies for my current Minimed pump. All the paperwork (including c peptide test) has been submitted by my endocrinologist and supplies distributor. Medicare requires up to 60 days to make a determination. It’s been 30 days now, so it shouldn’t be too much longer …
Gerry