We tried, but as we learned you can’t defeat Big Brother (Government). Maybe the Orange Prince(Trump) will do something about Medicare, LOL now that he is POTUS. It took me 40 years to get VA benefits from Agent Orange Exposure after serving in Vietnam. So that should tell you something about how fast our Government works.
FYI: there are a couple of other Tubeless Pumps that were to come on the market to compete with OmniPod, but have not received FDA approval. One was called the Amigo, from Nipro Corp, and I just learned that Nipro located in Florida pulled the plug on it because the FDA had issues with it. The other tubeless pump in development is called the Jewel made in Switzerland by Debiotech. This Jewel is still under development for over a couple of years now, and only God knows when it will be available in the US, that is if it can even get FDA approval?
Sorry, but I can’t help you with any info on the pump that delivers Nulasta for chemo therapy. All I know is that they do have their own patent.
I keep watching for those tubeless pumps, but I doubt that a) any of them will have FDA approval before I get to Medicare age in two years, and b) that they will have any more luck than Insulet in getting Medicare approval. If one of them did, that approval may open the door again for Insulet to re-apply and get the proper coding in place for the Pods. Until then, I just have to decide if I want (huh-- will be forced to) go back to MDI or whether I will try to stash away the approximately $3600 a year that I will need to buy OmniPod outright from Insulet. Life is choices… and sometimes neither of the choices are very good.
Thanks, again, for all of your time, money, and effort you have spent trying to get Medicare to cover something that is, in essence, a very simple change for them. Of course, my 93-year-old mother has already warned me, “Don’t count on Medicare for anything. They don’t pay $%!&.” She’s feisty, but she is correct.
God Bless your mother as she is very wise and right on in knowing Medicare doesn’t care about folks with Diabetes, or any other Debilitating illness. As I said before, Medicare hopes we will just go away and die, that way they do not have to pay out anymore claims on our behalves. I’ve been on Medicare for almost five years now, and we absolutely hate dealing with them.
I started paying into Medicare in 1966 when it became law, and I first started to work after high school, and this is what I get for all those years. That’s another reason why we have supplemental insurance to help pay for the 15% that they do not pay. However, they pay nothing for the Pods as you know by now, and as you said $3,600 is a lot of money to pay out-of-pocket each year. When I had Private insurance though my employer my wife’s Pods were paid for in-full, but once we both went on Medicare life became a challenge we weren’t expecting. Also, the VA is not much better when trying to get scheduled for care as I also found out over these past five years. Although, like it has been said no one said life was going to be fair so we do the best we can and move forward. Hopefully one day they will have a true artificial pancreas and Diabetics won’t have to suffer so much.
In reading the appeal, the problem appears to me that the OmniPod doesn’t conveniently fit into the DME definition because it is unique in the insulin pump universe and essentially needs its own classification. It needs to be called short-term DME, or STDME (or perhaps recyclable DME, R-DME) and CMS (and their contractor) need to use a “reasonable person standard” to define the OmniPod as DME.
IOW, if all other insulin pumps are DME, and the OmniPod performs an equivalent function to other pumps, then a reasonable person would define it as a pump (this is probably what the ALJ did).
Also, OmniPod/Insulet needs to stop defining their device as “disposable”.
By all means you are not beating a dead horse. As you pointed out, had the manufacturer - Insulet clearly not dropped the ball here, and done their homework before classifying both the PDM and the PODs. Because Medicare does PAY for tubing on some other insulin tube type pumps. Tubing gets disposed of after 72 hrs use just like a POD does, but the POD is not considered Disposable Medical Equipment (DME). Had Insulet originally designated the PODS with an HCPCS code K0552 versus the HCPCS code A9274 we wouldn’t be having all these distress issues with the OmniPod Insulin delivery system thru Medicare. Our Lawyer tried as she might to convince Insulet of this snafu, but their management kept blowing smoke, and continued to sit on their hands on this matter. Therefore, we fought the good fight and tried as we may, but as I said Big Brother wins out until Congress decides to change the laws.
Please continue to write to your Congressman and Senators and sign on-line petitions to have this law changed so the younger diabetics won’t have to fight with Medicare (if there will be a Medicare) when they reach age 65.
