Denied pump--numbers are TOO GOOD? ARE YOU KIDDING ME?

Agreed - I could easily live with even going back to the NPH days as long as I had a CGM!

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No doubt that the newest state of the art product is no less expensive. But if you were to price a model that has been around a while, you would see a significant drop in price…Much like computers today.

I have to second that. Mostly you get the enthusiastic view from people, and there’s no question that there are a lot of good things about it, but it was months before I felt like I had it dialed in to where I was back on MDI. Some people have a lot less trouble so I’m not claiming to be typical, but if all you hear is the positives it doesn’t prepare you for dealing with some of the frustrations and annoyances at the beginning. It’s a much more complicated system with many more failure points than a pen injector and I think I’ve experienced every one of 'em. I came within an inch of throwing it at the wall more than a few times. Glad I didn’t, mind you, but it’s not all glitter and unicorns.

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Ugh. I’d have to draw the line at “easily.” Sure would be easier than it was in the bad old days of matching strips to the colors on the tube, I’d go that far.

Wow… that is awful. So sorry that you were denied. I can’t really fathom why except to save them money. I think an appeal is the only way to go and hopefully you will win. I spent 2-3 years on mdi and I was just saying I’m not sure how I survived it. There is no need to stay on mdi for an extended period if you’re not happy with it, at 3 months you have learned enough about yourself and insulin.

Btw, that is the policy in the UK, so someone told me, that if you’re “stable” on mdi you aren’t allowed a pump. It’s really all about money in the end.

A pump is much better for me so I never want to go back to injections ever unless some miracle comes along which is really more stable. The tslim is very good btw too. I hope you get one soon. Good luck!

Also I forgot to add that the main thing about a pump, which maybe no one here as mentioned although I’m sure some are aware of this is that you can CHANGE BASAL and increase or decrease insulin for highs and lows… with MDI you can’t do that, that is why it’s much, much better for irregular blood sugar and lows/fluctuations etc.

Congratulations on getting a CGM so easily. Some of us had to fight years to get one, are having to fight to keep getting the sensors and transmitters, and who knows what happens when we turn 65?

I pumped for awhile, then went back to MDI. On a pump, you will need to know how to calculate corrections and use a syringe to take the correction when the pump doesn’t give you insulin. With smaller doses, the pump won’t alarm even when your blood sugar is over 400.

Funny you should ask about what happens when we turn 65. New rules is what happens.

  • no CGM on Medicare. You pay for it yourself as I do or stick with finger pricks.

  • you can have any pump except the new ones that are not defined as DME (durable medical equipment). E.g. Omnipod /T-slim are not pumps, they are expendable like infusion sets, not durable like the all-in-one pump/controllers, One-Touch Ping and Mini-Med.

  • in order to get a pump you must prove you are a T1D; previous medical diagnosis not-withstanding. You do this with a blood test for c-peptide whose result is zero or very near zero value. (see horror story on that below)*

  • you get the cheapest lancets known to man-kind and a lancing device that mostly will lock and hold the spring. Better to buy Walgreens/CVS or other generic for both.

  • BG meters are normal suppliers, e.g. One-Touch etc. They will provide you with a back-up too.

  • Pump, test strips, lancets, infusion sets, etc are shipped from Medicare contractors every 90 days PROVIDED - you have less than a 10 day supply of these items AND you have seen your Endo or Nurse practioner within the last 90 days.

  • Insulin for the pump is covered at no cost by Medicare Part B, not Part D. It is provided by Retail or Mail Order Pharmacy who will charge you under your Part D plan until you raise enough heck or find the one knowledgeable person who knows it is free under Part B.

  • You will need a good supplement plan to help cover the costs not covered by Part B. Plan type F is the best given all the blood tests and doctor visits to manage diabetes and its potential complications as well as normal aging problems.

  • Forget all of this if you choose a Part C plan otherwise known as Advantage plans. They all have their own rules.

*Now my c-peptide horror story: my first blood test result was 10.0, i.e. I was not a diabetic at all. Who would have guessed that I really did not need the insulin I had been taking for 34 years. Amazing. A change of doctors and a change of labs corrected the results. I never heard which patient got my results and a diagnosis of T1D.

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To be precise, they don’t care what type you are. What they care about is that your c-pep is < 0.2, i.e., 0.1 or zero.

+1 on Plan F. Best way to go.

Re: No CGM coverage under Medicare–there are bills pending in Congress to fix this. They are S.804 (Senate) and H.R. 1427 (House). If you haven’t already, you should write your Congresscritters and urge them to cosponsor or at least support these bills. It’s an uphill fight, every voice counts. More info available at diabetespac.org.

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Actually I believe Medicare says that your c-peptide has to be lower than 110% of the lower end of the lab normal range with a concurrent fasting blood sugar of < 225 mg/dl in order to qualify for a pump. Many if not most private insurance companies mirror this criteria.

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Interesting. My personal pump “expert” was the source of that information. I’ll have to question him more closely.

I just got the EOB for my new tSlim. Insurance was billed close to 10,000 for it. Of course they have contracted prices for what they will pay, but yes the newer the technology the more expensive it is. That being said we still aren’t seeing any significant reduction in costs for older pumps like Medtronic. There prices have remained right around that 5000 to 7000 range.

@John_P You are mistaken about the t:slim pump not being covered by Medicare. It is a traditional pump and I know several people on Medicare who are using it. I wonder if you are thinking of the Snap pump which unfortunately has been discontinued. Like the Omnipod, it was not covered by Medicare.

Brian, what is their benchmark for “lab standard”? Labs vary from one to another. Does Medicare just reckon from the standard of the lab that performed the test, or do they have their own specfic threshold?

This. I see many people disagree with this statement, but this is exactly how I feel. I think at three months I’ve learned enough to be able to decide if I want to be on a pump or not. I’ve been carb counting since the beginning, using a carb:insulin ratio, and I know how to do corrections if needed.

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I appreciate the reply, but I disagree. I was able to successfully manage injections, carb counting, and handling corrections after about an hour of training. I honestly don’t think a pump would be that different and so complicated that I wouldn’t be able to figure it out. And if that is the case, it would make sense to get the pump now to get used to it while my BS is stable during honeymoon.

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@David_dns

I think I’m in the same boat as you now. :wink:

@Buckley83

Hello from NYC!

I have to agree w/ what you wrote in regard to a CGM. A Diabetes Educator and I are in agreement that I would do better w/ a CGM rather than a pump. (If I had a choice and had to pick in between the two.) Unfortunately, my insurance has done away with CGM coverage for EVERYONE a few months ago.

@Terry4

I just replied to someone earlier with the same sentiment. If the insurance company would pay for the CGM instead, I’d gladly not get the pump.

@jtenneson

I just wanted to congratulate you also on lowering your A1C to nearly a half of what you were initially diagnosed with!

Like many others have noted, I am also sorry you are having all this difficulty with your insurance. If you have not done so already, I also agree that you should appeal or have an attorney do it for you.

Much continued success to you!!!

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My insurance was billed 4k for the tslim G4 last year. It varies a lot.