Thanks for the info, Ruth.
Let's share information, and not drag politics into it please ;) I've learned already from these posts.
I have Medicare as Primary and Mutual of Omaha as secondary insurance. I can't speak for anyone but myself, but if Medicare denies a claim for test strips, then my secondary, Mutual of Omaha will also deny the claim. It does not matter if I provide downloaded blood glucose numbers every 6 months, I am still denied anything more than 3 strips a day. How does one have a good quality of life when the very thing that helps control my diabetes is being denied to me? I can assure anyone that I am not selling my strips on eBay and anything else like that.
Bayer sends out a coupon with their Contour Next Link that allows a certain amount of money toward a co-pay........however it does not apply to Medicare recipients.
Mayumi:
Thank you for sharing your experiences. Testing is key to controlling diabetes - type 1 and 2.
For last two years I have done the full trip, Doctor's scrip, doctor's log book data and my own log sheets printed out by computer and done every 6 months.
I have fought both Liberty and Noridian and that c2c SOlutions ( Independent contractor owned by blue cross) and yes i have gotten my 10 strips a day. Why this has to be the reward for taking care of oneself and stopping/controlling diabetes totally escapes me as a 30 year type 2 diabetic.
I have Humana on the seconday and generally they have done good job for my wife and I but like Mutual of Omaha; if medicare outright denies it, so does Humana.
Therefore I appeal vociferously to Medicare and its cms contractors and to the Medicare Omsbudman as well.
Unfortunately, one needs great patience and persistance and you too can have sufficient paper backed up and stacks of files like a small law office.
Contrary too arguments made in this blog, Medicare is under the gun to cut,reduce/defund certain levels of care and I would add even if that care is defined necessary by one's doctor.
Mayumi:
It is true many secondary plans pay only on the basis of what medicare will pay and if medicare denies the claim then the secondary insurer will not pay anymore than what medicare will pay. In some cases and in some markets a secondary payer will establish higher compensation rates. For instance mine will pay more than the medicare limits.
Mayumi, in your case you will need to fight the battle with medicare and get them to increase you number of strips allowed. I wish you the very best, it is an uphill battle but the battle can be won if you are persistent and get a decent review manager.
Thank you both gentlemen. It is indeed an uphill battle especially when one's doctor treats them like a leech. He also told me I was obsessive/compulsive for testing more than 3 times a day, my A1C of 5.7 means that I am having too many lows, so I should raise my basal so my A1C is 7 or more. He told me that because I take Metformin I have to be Type 2 because Metformin is only for Type 2 diabetics. He referred to himself as a Diabetic Specialist but he did not know what 'FBG' meant on my list of times of the day that I check my blood sugars. I told him FBG was fasting blood glucose and he just said "never heard that one".
How does one go about getting a review manager? Sorry for my ignorance.
Mayumi:
Unfortunately, your Doctor does not seem compatible to your crucial need to get your diabetes under better control.
In its simplist terms the two of you are not seeing eye ball to eyeball.
In its most positive terms his pratice and experience have led him to these attitudes and thinking and successes he may have had. In its worst, he is standing in the wrong dead end mine tunnel with the lights turned off.
Simply put, you do not have time for him to come up to speed on your situation nor arrive at a more naunced view and sympathy towards it.
Homestly put, while easier said than done, you may need to find a different Doctor with more understanding, more flexible in mind set as well as willing to take the patient time to get a better handle on your case without spooking you out.
In electronics we refer to this as the difference between a analog world - infinite shades of gray and the one/ zero mentality of the digital world.
While you work this out; be sure you check out the excellent web site of Diabetes Self Management and its bloggers from Amy Campbell, Jan Chait, David Spero along with their reference sources to further assist you.
Best wishes and good luck in your quest for better health.
Regarding a better technical review manager, I appeal till I do!
well here is latest data on Liberty Medical Bankruptcy - chapter 11 on Diabetes Self management Bog.
Posted by Louis P. Sznkovics | Mar 13, 2013 at 11:18 pm
Liberty is out of business.
Posted by Jamie | Apr 12, 2013 at 3:00 pm
I should say Liberty is out of the diabetic testing supply business.
Posted by Jamie | Apr 12, 2013 at 3:21 pm
I also saw article whereby Medicare is attempting to cut medical testing supplies by 72 percent.
Neat, theres a nifty trick. Who do you think this is going to impact?
I will be starting Medicare in November, but my situation is a little different in that I am CalPers which is the California state employee program and CalPers integrates with Medicare so the coverage is better than the (good) coverage I had as an employee. But don't most people have some form of Medicare Supplement so are not limited to what is allowed strictly by Medicare?
With regard to test strip coverage with Medicare, the rules have to do with Medicare Part D. My retiree coverage provides prescription coverage that is better than the Part D coverage. This allows me to refuse the Part D coverage without incurring any penalties. Does your CalPers plan provide post-Medicare prescription coverage? If it does then, as of now, you won’t face the Medicare test strip rationing that has been covered in these discussions. Medicare supplemental plans may or may not have prescription coverage. If you have no post-Medicare Rx coverage in your retiree benefits then you’ll need to sign up for Part D (in addition to the other required parts) and deal with their test strip rules.
Studies have shown that more strip usage equals better outcomes. Medicare is being penny-wise and pound foolish in this policy. It sounds like a policy uninformed by medical reality. It’s good that they do make exceptions for the persistent.
Ah, thanks for clarifying that, Terry! Yes, CalPers also has prescription coverage that is better than the Part D coverage and we are actually required to refuse the Medicare Part D. So my test strips like my meds will stay the same. Thank you!
But I'm still outraged on the part of the Medicare patients it DOES apply to because, especially with older people, you are right, they will in the end pay out more to cover the increased health problems from reduced management that comes out of reduced testing! Yes, it's good there is a way to override with a bit of effort and cooperation from your doctor!
JMS:
With all due respect, it seems to me from what you are posting, that the problem is with your secondary insurance. Medicare pays for what they are going to pay for and their definitions are rather clear. I don't agree with a lot of them, but that is my problem. Secondary insurance is intended to, within reason, close the gap in coverage for what Medicare does not pay. It has nothing to do with the Affordable Care Act and what that act cut out of Medicare. Were you to do your homework, you would find that what the ACA cut from Medicare was nothing but a big, wet, sloppy kiss to the insurance companies, reimbursing them for double coverages in cases. It looks like good auditing to me. Comparing coverages with the competition might be a good pass time for you, as long as you are unhappy with what you have.
Thank you, Rick, for keeping the facts clear.
I have 200 strips per month, plus 100 percent of the supplies necessary for my pump to run. Medicare, and my supplimental insurance company is pretty good.
I agree about the ACA, Judith! I am going to guess that ten years down the road, we will wonder how we got along without Comprehensive Health Care for as long as we did.
I am wondering if all these haters of the ACA will refuse its coverage when they really need it.
Not only will these haters of the ACA accept coverage but their memory will dim and they’ll claim that they’ve always supported it! I don’t expect to see many blog posts five years hence that proclaim, “I was wrong about Obamacare!”
I have medicaid. and medicaid does the same thing, they will only approve payment for 1 - 3 strips a day. I appealed it, but had to get my doc on board with me. They pay or approve whatever the doc prescribes, and so I kept track for two weeks of the number of strips I used per day. What happens when I don't test enough, and when I was testing. I found that if I don't gush with blood, the strip or meter gives me an error reading, it might take me three strips to get a reading. The first time I had a low during that period, I used four strips to get back on track.....the doc realized that it wasn't just one strip, but many that I could be using.
I also went to my county health people begging strips. I asked the doc for samples, I went to our hospital education department and got more. I also (am not proud of this) but ordered meters that stated they come with strips for free. You do what you have to do....and that's the only answer for now, that I have found.
excuse me a minute. I have Part D in my bag of medicare coverage. It has nothing to do with diabetic test strips as far as I can see. My strips are covered under rebular part B medicare plus my supplement plans. In addition; all strip claims are reviewed by a medicare DME(dureable Medical Equipment ) CMS service center.
You’re right and I stand corrected! I’m still five years away from Medicare age and I assumed that the strip coverage was part of the Part D prescription plan. Your comment sent me on an overdue visit to the Medicare web site.
As you said, mail order diabetic supplies are under the Part B durable medical equipment coverage. Who would’ve thought that our test strips would fall under a “durable” description??!
It’s still my understanding that for people who have post-Medicare mail order private coverage will be able to secure strips under that coverage and not be subject to the same scrutiny as the Part B coverage.
I tip my hat.
Today, I found ths summary set of statements about the budget cutting at Medicare and that diabetic strip/testing supplies was being cut over 70 per cent.
I have no way to ascertain the veracity of this but have seen other statements out there saying similar things:
"Medicare reimbursement will be cut by an average of 45% for suppliers participating in Round 2 of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program, CMS announced on January 30, 2013. Medicare reimbursement will fall even more dramatically under the national mail order competition for diabetic testing supplies, with payment reduced by 72% compared to current fee schedule amounts (and under the terms of the new “fiscal cliff” law, these prices will be applied in the retail setting as well). Round 2 and national mail-order contracts and prices are scheduled to go into effect on July 1, 2013. CMS estimates that competitive bidding will save the Medicare Part B Trust Fund $25.7 billion and Medicare beneficiaries $17.1 billion between 2013 and 2022.
By way of background, under competitive bidding, only suppliers that are winning bidders, meet licensing and other standards, and enter into a contract with CMS may furnish selected categories of DMEPOS to Medicare beneficiaries in competitive bidding areas (CBAs), with very limited exceptions. Winning bidders who sign contracts are paid based on the median of the winning suppliers’ bids in the CBA, rather than the DMEPOS fee schedule amount. The Round 1 “Rebid” went into effect January 1, 2011 in nine CBAs, involving nine product categories. Payment amounts under the Round 1 rebid average 32% below the Medicare DMEPOS fee schedule amounts. CMS has recently conducted a “recompete” for six product categories in the Round 1 Rebid areas (including additional products) to take effect in 2014.
Round 2 will take place in 100 CBAs covering 91 metropolitan statistical areas, with three-year contracts effective July 1, 2013. CMS announced yesterday that the weighted average savings by product category are as follows:
• Oxygen, Oxygen Equip. & Supplies - 41%
• Standard (power & manual) Wheelchairs, Scooters, & Accessories - 36%
• Enteral Nutrients, Equip. & Supplies - 41%
• CPAP/RAD & Related Supplies & Accessories - 47%
• Hospital Beds & Accessories - 44%
• Walkers & Accessories - 46%
• Support Surfaces (Group 2 Mattresses & Overlays) - 63%
• NPWT Pumps & Related Supplies & Accessories - 41%
CMS also conducted a national mail-order competition for diabetic testing supplies concurrent with the Round 2 competition. CMS announced that Medicare payment for diabetic testing supplies (100 lancets and test strips) under competitive bidding will be reduced from $77.90 to a national rate of $22.47. While the competition for diabetic testing supplies was intended to apply only to mail-order suppliers, it is important to note that the American Taxpayer Relief Act of 2012 (ATRA), which was signed into law on January 2, 2013, sets Medicare payment amounts for retail diabetic supplies at the national mail order competitive bidding single-payment amounts, effective July 1, 2013. In other words, as a result of the ATRA, the competitive bidding process is being used to reduce pricing for DMEPOS other than items that actually were subject to competitive bidding. This policy was adopted despite CMS’s previous acknowledgment that "there are pricing differences between mail order and non-mail order diabetic testing supplies because of the delivery methods for these supplies." Even though under competitive bidding program rules, only successful bidders that sign a contract with CMS will be eligible to furnish mail order diabetes supplies to Medicare beneficiaries as of July 1, 2013, Medicare beneficiaries will not be limited to using contract suppliers to obtain retail/storefront diabetes supplies. In sum, a Medicare beneficiary must use a contract supplier to obtain mail order diabetic testing supplies, but can pick up diabetic testing supplies from any local retailer; the payment to the supplier and the beneficiary copayment will be the same in either setting. (The ATRA also temporarily reduces fee schedule amounts for retail diabetic testing supplies to mail order amounts from April 1, 2013 until the national mail-order program single payment amounts start on July 1, 2013.)
CMS next will be mailing contracts to “winning” bidders. According to a CMS fact sheet, 14,654 contract offers will be made to 867 Round 2 bidders, who have 3,109 locations to serve Medicare beneficiaries in the CBAs. CMS also will offer 15 contracts for the national mail-order program; the national mail-order program winners have 48 locations in all. CMS notes that about 62% of Round 2 winning suppliers are small suppliers (gross revenues of $3.5 million or less), and 33% of national mail-order contract offers will go to small suppliers. When the contracting process is complete, unsuccessful bidders will be notified of the reasons they were not offered a contract. CMS expects to announce the names of the contract suppliers in the spring of 2013. CMS and the Competitive Bidding Implementation Contractor (CBIC) also will be stepping up educational activities leading up to implementation of Round 2 and national mail-order bidding."
Cheers!
I am curious what input that all of us Diabetics have had into this process that seems at a very advanced stage. Did I miss notices requesting input and feedback from all of us diabetics so affected by what seems as sweeping decisions made behind closed doors without any consensus. On those directly lobbying for Diabetics - have they been part of this decision process and status.
Although not on medicare yet, I am a medicaid recipient. Yesterday I got a notice that my supplies would no longer be accepted with medicaid payments.....so started looking for another company that would pay for my supplies or at least turn them into medicaid for me. Out of 10 companies I contacted 6 will no longer submit to medicaid. GREAT! NOT. Without that help I do not have resources to pay for strips or testing supplies. I did at the end of the day get a call from CSS and they will take my medicaid payments, but I worry about for how long, My husband is 63, not eligible for medicare yet, and his work insurance stinks as far as diabetes supplies is concerned, So don't know where to look for help with his supplies. What happen to those happy golden years we were always told about?