Agree with Dave 44, I think the biggest asset is your endo/(doctor) knowing the game and willing to take the fight to outlast medicare. I was on a Libre CGM for three months (via medicare), and it just wasn’t working well for me and I than got a my endo to talk to medicare and she got me a Dexcon CGM in a couple of weeks. It was her doggedness and knowledge of what to say to medicare that generated the result I needed.
1 Like
I have been on a pump since 2009, covered by my husband’s insurance and my Fed BC/BS. I lost my husband’s insurance when he retired and had to go on Medicare part B , with my fed insurance as secondary. Two years later, my Animas went out of warranty, began having occlusions. Animas had just gone out of business, so needed new pump.
Then the fun began! My insurance told pump distributor that they would totally cover the entire cost of new pump (Tslim X2), but they needed a rejection letter from Medicare because I was Type 2. But the pump distributor would not submit my info to Medicare because they said I would be rejected. A totol catch 22. Tandem was not in program with BC/BS, so I needed to go through a distributor as Solara.
Thought I would go crazy. On a three way phone call, I heard Fed BC/BS say they would completely pay, just ‘please send a reject notice’, the Solara ‘no, sorry we won’t send her info because Medicare would reject her’.
Around and around we went. No one at the Diabetes Care Center had any suggestion. Then, for I saw family practice doc for a non-diabetes visit. Told him about this. So, he had new blood work done and my C-peptide level was low, so qualified to have Medicare pay for pump. Doc says that insulin resistance is not my problem, pancreas produces small amount of insulin.
So, my problem was solved but Solara told me that there are Type 2’s who need pump but can’t get it because C-peptide test shows too much insulin. Insulin resistant Type 2s may produce a fair amount of insulin but need more due to resistance.
I am on Medicare and needed a pump with a C-Peptide of 3.5. I had to buy my own pump and supplies for about 3 years. My doctor kept testing me every 6 months or so and I started dropping to 2.5, then 2, 1.5, and finally 0.8. So now I at least get Insulin with part B and coverage for my infusion sets.
I worked each time to get C-Peptide low by getting tested when it was low as possible. I knew when my pancreas was worse because those days I needed more insulin (independent of any food). I also made sure my glucose was around 70 when I got tested and sometimes had to walk the halls for an hour or two before a test.
I can still get readings in the 1 range sometimes but you only need to pass once. I passed twice but now the doc skips the test.