Does anyone have suggestions as to how to prepare for the apparently inevitable problems of getting an adequate number of glucose test strips and other supplies once I turn 65 in a few months. Are there things I should do now? My doctor says Medicare only approves one or two test strips a day. I use 7 to 10, depending on the day, and what activities I'm involved with on that day. I also have the CGM device, which I understand is not covered. I will have supplemental insurance. Has anyone tried appealing these decisions by both Medicare and the supplemental insurance programs, and has anyone had success? I did talk to someone at Dexcom who told me they aren't even trying to get Medicare to approve their device. That is frustrating to me, since I find the Dexcom much more useful to my general control issues and quality of life than any other device, including the insulin pump. I have Type I diabetes.
i have tried for several months to get my CGM approved. It will not happen. I appealed, applied, and wrote my congressperson. No luck, it wont happen. Now here is the worst part, you need medicare to deny the purchase so your secondary insurance will cover it. For months medicare took the stance that since they are not eligible, they would not deny them. They simply ignored the request. I needed a disapproval, not an ignore. Finally I got a denial and I could file with the secondary and they were paid as before.
Unfortunately my supplier of CGM sensors required 100% payment before they sent the sensors and they refused to bill the secondary provider. I finally found that Minimed would carry the account and bill the secondary. Sometimes it takes medicare 6 months to deny the request. I also found that Liberty medical would carry the CGM account and they are so much better than minimed. So I am going to liberty as I need new supplies.
On test strips you need to show that you test as much as you say. Keep a complete log and usually they will honor the number of tests you show. but only with a complete log for the past 3 months. if you say 7 and you record on average 5, 5 is what you will get. Keep very good records.
As another one on cgms and 10 strips a day; I appreciate the information stated here.
I am in same situation and dealing with Medicare can be horrensous.
For my test strips; I use 10 a day and it took massive fight and getting prescription from doctor and documentation of need as well as submitting log of fingerpricks documenting usage twice a year ( was every 3 months - now every 6 months). This was even using a valid contractor who deals in this stuff and bills medicare.
It took me over a year with all the issues described and dealing with my congressman to finally get them to pay for sufficient diabetic test strips.
I was saving the cgms for round 2.
As a sick person with serious type 2 ( 30 years as T2 64+ years old on disability after a stroke , I consider this abusive behaviour an unacceptable disgrace. I ve worked all my life, came here as legal immigrant many years ago paying my own way in 1980's and fed up with all those conning the system and getting full coverage - no questions asked especially the illegals.
My tax stated medical costs were $ 24,000. 4K for supplement plans, $6K for test strips initially at 30 a day and $ 3700 for cgms. It was more important to identify and fix problem than sit on one's hands rotting out.
I am fed up with all the illegals waltzing in this country and get free services walking into hospitals et all.
I am fed up with the discrimination. President Obama can shove it. Everybody should pay their share - not just the one per cent.
Omk I can tell u that if u get a scrip from ur DR stating how many times u test a day maybe it will be over ridden. Mine has. No Medicare dosen't cover CGM's. I'm not 60 whatever the requriement is now but have been disabled for quite a few years and Medicare is my main provider I have a supplemednt insueance too. Also be sure to log every test u do me)do for 30 days b/c it's a requirement. THey will send u a log for that (atleast they do me) I don't wanna get into more abou Medicare b/c it makes me ill if I do
i agree, it makes me sick as well but I do appeal this nonsense.
The latest info I received said they needed log every 6 months now. Previously it was every time contractor sent in Bill to medicare - every 3 months.
I use the software for logging the fingerpricks that prints out log of all tests and times as well as averaging number of tests per day. That helps save time.
The sicker one is, the harder one has to work documenting the need. Talk about S & M punishment. Testing is only way to shake this crap down and keep under control.
I would love to know who the witless/brainless idiot who suggested one a day strip for type 2 diabetes as the basic allowable allotment.
For a perfectly healthy person that would probably be sufficient. For a Type 2 from pre-diabetes to full and multiyear impact, one a day strip usefullness would range from extremely limited to outright useless.
Agree with u!
Thank you, Rick, for the really useful information. I didn't realize I had to get Medicare to deny before asking my Supplemental insurance to pay. Can you tell me more about how you got the denial? I hate keeping fingerstick records, but I'm currently using WaveSense, an App for my IPod to record them. It helps. My problem is, of course, that I don't always record every fingerstick. Now that I've got the CGM, I'm checking so many gadgets, it becomes mind-boggling. And printouts! Boy, do I have printouts.
I will take your advice and keep good records, and print them out, and then keep the printouts. That's been a problem for me because I get tired of all the paper accumulating in my home office. Charts, graphs, logs, you know what I mean.
Are you saying that your secondary is now going to pay for your CGM sensors? Again, thank you for the really useful information. I appreciate it.
I agree that Medicare doesn't make it easy, but neither is it impossible to get the test strips you need. I just went on Medicare last August, and I'm getting 10 strips a day.
First, I have a supportive doctor who has no trouble writing scrips and justifying why I need to test 10 times a day.
Second, Medicare does require you to submit a 30-day record of testing. I wasn't aware I was going to need to do this, and since I use 2 meters, I ended up spending a couple of hours scrolling through the memories of both meters, trying to enter the tests correctly.
Now that I know, I'm going to check with my supplier to find out when my next "log jam session" will occur, and I'll just keep a written log for that month.
Don't know about the CGM, though...never tried to get one.
Very good. glad it has been so easy for you.
as stated, latest regs released to me indicate two log entries of 30 days twice a year. prior was every 3 months.
i agree, some folks get through onslought relatively easy others go through hell
that does not make it right nor help diabetics in any way.
i came close to filing a suit over it.
that nothing is impossible does not mean nothing/imply is ridiculous or crap!
The latest foray; some drugs were denied at level 1. My Doctor appealed without success.
I appealed and pointed out that as a result of getting my Diabetes under control drug costs dropped from $ 6100 to $ 2600. My doctor was paid and i received a letter from Medicare in late January confirming my claim paid and everything was copisetic.
Not to be outdone by Medicare, I received a letter dated March 13, 2013 from A farce independent medicare contractor - C2C Solutions fully owned by Blue Cross of Florida stating that my appeal had been denied. I contacted Medicare, thanked them for their help and was advised that yes at Level 2 appeal; I had received a favourable review and that was why claim were paid. They could not explain this nonsense from C2C Solutions.
I am greviously fedup with this Obamam Medicare crap, I am a serious type 2 diabetic disabled due to stroke in 2007 as well as my wife disbaled all her life, glad to due my duty and pay my part but this crap out of a bunch of smart asses from Flordia is unnacceptable.
I spent all day on the phone Friday, April 5th, 2013 attempting to get a respectful response from C2C Solutions and unable to contact any live body over this mess.
Maybe I am wrong, it seems a class action suit is needed here to get respectful response to this disabled person and his family.
Medicare allows you any number of test strips as long as you can prove you're using them...doesn't matter if you're T1 or T2, as long as you're on insulin. I test 9-10 times a day, and once every six months I have to submit my blood glucose log to prove that I actually test that often, but once that's done...no problem getting enough strips.
Also, you can have a low C-peptide and still be a T2, as I am. I was never tested when I was diagnosed with D 29 years ago because I was already nearly 40 so it was assumed it was T2. I finally asked my doctor to do a GAD antibody test (since I had to do a C-peptide for Medicare), and the GAD was negative.
Interesting fact: if you have to do a C-peptide for Medicare, make sure your blood sugar is low when you do it...if it's high, you'll have a high c-peptide. I had to repeat mine because it was high the first time, but the second time I went in with a bg of 75, and my C-peptide was 0.3.
I'm sorry I did not see that you asked additional questions. I apologize.
What you need to do is get you supplier to submit your CGM's to Medicare and they will deny them. I use liberty medical and they will do this and better still they will carry the cost of the sensors even while Medicare denies them. Then the supplier will automatically submit them to you secondary provider. Now please understand you will still likely have a fight with your secondary insurer. Fortunately my secondary insurer had already agreed to cover my sensors before medicare became my primary provider. So this was already on rails when I went to medicare. At any rate you need to get approval for you sensors from your secondary. Once the secondary get the claim they will act accordingly. When picking your medicare secondary provider ask them if they cover sensors, not all do. My secondary is an employer sponsored plan so I do not have a typical medicare secondary. This is good for sensors, bad for other stuff.
Anyway check the secondary insurers before you select it.
With test strips, I do not interact with medical on this issue but theoretically, they should work the same. Be sure you qualify a secondary with the question about strip payment. This is different than the secondary provider mentioned above. Strips are issued through your pharmacy so what you need to do is question your secondary prescription provider before you choose one. Again I use an employer plan for all scripts so I avoid this issue with medicare.
If you need additional help please let me know I will be delighted to help out if I can.
This has absolutely noting to do with the affordable care act. These rules have been in place for many years. I do agree that the medicare standard is wrong, but instead of tossing around ideas of what made it wrong is both not helpful and it demonstrates a serious lack of knowledge.
I am glad you seem to be getting things resolved. It is a tough road.
I couldn't disagree more.
Yes at one technical level the aco/aca act is separate and apart from medicare strip policy but does not change the facts that another layer of crap as been added to put Doctors at the bottom of the feed chain and reduce their influence and impact on making decisions on ones care and putting the ACO/ACA in charge with the death panels over ones Doctor one has selected and been using. That is a violation of the Constitution, restraint of trade and interference in my care by my Doctors.
I have spent the last two years appealing rejections on each and every bill for strips and denial by medicare not withstaning following proper procedure and required Doctor's documentation.
After getting my drug costs cut from $ 6000 at end of 2011 to 2300 at end of 2012, I resent your abrupt all or nothing comments.
Maybe not connected Rick but massive interference in the process and control.
My biggest problems getting my strips and other needed medical care covered has been fighting these BS review panels and their phony independent contractor review panels when these so called independent contractors are wholly owned subsiduaries of Blue Cross or others over riding my Doctors and their determination of the care I need.
In addition, it is not the lack of knowledge that is killing me in this; it is the knowledge of phony impropriety of a medical provider apparently owning the CMS contractor - DME-QIC contracting services to review claims but said same entity owns the Independent Review COntractor as well and then makes decisions that are supposed to be fair and demonstrate that in fact justice is seen to be done as well.
I call that a kangaroo court joke consistent with gerrymandering and ward politics.
This is straight collusion, comspiracy, violation of the American Spirit and history and our democratic form of government.
My party was not part of these new rules rammed down the throat of the American people without proper bipartisan review and snuck thru closed doors in the dark of night.
I object strenuously!
When I saw a doctor last Friday who was filling in for my GP (who is out on Maternity leave). he told me that since I have a Dexcom Gen4 system - for which I pay 100% out of pocket - I can rely on that to know what my blood sugar is ... thus I don't need more than 3 strips a day even though one Endo has stated I am Type 1 and I had a low (0.2) c-peptide.
I am fearful that I will lose my pump if my doctor feels like changing my electronic records and convinces Medicare I don't need a pump. When I was in the office he insinuated that I didn't need insulin either but that oral medication would be sufficient.
As I said and repeat once again, the medicare issue dealing with test strips has nothing at all to do with the affordable care act.
Thanks for trying rick, but folks only read what they want to hear. I gave up suggesting folks go READ the acts, the rules, and how to get what they need. It's more fun to whine and blame the government, the insurance industry, and the contractors, don't ya know ;)
Yes I do, but well I am a glutton for punishment and I have broad shoulders.
No, no I meant it I really do have unusually broad shoulders, I cannot explain it for sure.
And I am offended by these comments as a 30 year type 2 diabetic after a stroke at 62 and my reward for getting my diabetes under control and getting costs cut back 61 per cent is to read insensitive comments like those here.
All current data is suggesting that under this new ACA one will have all sorts of fun getting acceptable levels of care.
Medicare costs have been forced cut by Obama and the government needs to cut those costs. Test strips are an extensive part of the medicare cost layout and medicare needs to cut that and will use the Affordable Care act to do that.
All I am asking for is proper independent review and not by kangaroo court tainted processes.
I am not whinning. I spent my time working the processes to appeal and get my strip coverage. Wasting constant time on rejections and appeals just steals time from my time budget as a disabled person after a nasty stroke in 2007 to help my disabled wife who has been disabled all her life.
I would be whinning if I did nothing. nothing is further from the case. So I object to these short shift narrow comments.