Thanks Richard.
I think that in a truly absurd twist, a win in Federal District Court will only apply within the confines of that district until or unless the case is eventually appealed to the Supreme Court.
You have to win in your district even though you may cite the Wisconsin victory in your case. On the other side, if there have been district court cases on the same/similar issues decided in favor of Medicare and the current interpretation of the law, those cases will be used against you.
Do you have insurance? If so, why?
âInsuranceâ and âmedical careâ are not synonymous and we should have never come to view them as being so-- thatâs my pointâ thatâs why things cost what they do. Weâve allowed ourselves to be fleeced.
If health insurance had only ever evolved to be used to cover unexpected and unaffordable health costs (the same way every other type of insurance in the world is used) weâd actually have a real functioning market and the vast majority of healthcare costs that Should be affordableâwould be, unfortunately now they are not.
Why do you think homeowners insurance is affordable but health insurance isnât? And why are home repairs generally affordable but healthcare isnât? Most of us drive cars, and we can afford to insure themâ but we donât use that insurance to buy the car itself, or every time we fill up the gas tank, we only use it if there is an unforeseeable major damage â thatâs why both the car and the insurance are affordable. Think about it. I donât know what the solution is but I sure know you canât solve a problem while ignoring its root cause.
We are not empowered by a healthcare system in which almost every cost, even ones which should be small are out of reach of most individuals and therefore must be covered by an insurance pool. With that arrangement comes rationing, access limitations and so onâ we arenât empowered by that model, we are enslaved by it.
Edit to add: i do not agree with those who flagged this post as off topic. It is on topic to explore the reasons for escalating costs in a post about medicare coverage for devices, because if those costs werenât out of control we wouldnât need Medicare to cover them and we wouldnât even be having this discussion. I am looking at the root cause.
Yes, HYPO-UNAWARE. Drop into the 20âs before I am aware. Living alone is fineâTILL I awaken in the middle of the night, DRENCHED in sweat, barely able to moveâlet alone pick up the large bottle of glucose tabs I keep with me to take a couple! Itâs NOT that I donât eatâI DO! Night before last, I awoke, sweaty, unable to move (learned the next morning that I had bitten my tongue on the sideâas in a SEIZURE!); laid there till I could move & took 2 glucose tabsâŚthen another one. Started being able to move a bitâŚslowly. This went on for HOURS. Really have no idea how long I was THAT out of it. Had the phone with me, but my fingers wonât always work to where I could dial 911 anyhow! Have MedicareâŚwhat else can I say. They will not cover the CGMâs . Had a Dexcom. Used the last of the supplies as loooong as I couldâin hopes that medicare might WAKE UP. Guess they do not care how many people die. Seems, they couldnât care less. Have been Type I for > 50 years. Did the MDI since I was 12. Started on a pump end of June this year. A1C is 5.3ââthatâs too tight, you have wiggle room.â Basically lost the whole day. Got up with a terrible head cold. Then, this morning, got up with another low! Have been low all day today. Yes, supplies are (too) costly. However, not as costly as the ER or hospitalization. A CGM WARNS one that their going low or high. Yes, we do have some sense of what is going on from the food choices that we make, but itâs a blessing indeed to be able to see that graph saying youâre trending down, & then to BEEEP when you really start going low. A Pump is great! Really like not taking injections any longer; but it does not indicate in any way what my blood sugar level is doing. Aware that Iâm stating the obvious, but this has really thrown me for a loop; ending up with seizure-like behavior. What are we to do!? LORD, help us all.
You asked, why do you have health insurance. I answered the question. Do not berate me for answering a question you asked. I do not enjoy insults. Please stop. I donât come to tudiabetes for political harangue.
I would like you to comment on my post after reading it. I would like you to pick an idea you appreciated. I would like us to find something we enjoy discussing that would build us both up. Donât rage against the first three words of a page full of interesting topics. If you disagree that medical insurance is for medical care then move on. Letâs agree to disagree.
Not insulting you, have no reason to. Just exasperated with the healthcare system in this country and how it escalates costs by design⌠And frustrated there doesnât seem to be any way to fix itâŚ
Disallowing medical care for the elderly and indigent to negotiate costs is a good example. Lobiests who are trained to get lawmaker attention and away the to the program their employer pays them to profess is a good example. Well funded research with irrefutable results is a good example of possible progress.
I do have insurance, lots of it actually⌠I have it not only to insure against the unforeseen, which is what I believe it is actually good forâ but also (unfortunately, in my view) to cover almost every single medical expense my family encountersâ I have it for the second purpose not because I think that is the way it should be, but because I believe unfortunately thatâs the model our society has been duped into adoptingâ which I believe has been the primary floodgate to runaway costs in healthcare.
Even better than lots of medical insurance, is good health!
Hi Sissy, do you have the Joslin 50 year medal? If you do, there is a Joslin medalist group on Facebook. I really love that group, it is a secret group where nobody except other medalists can see what you say. It is very private! It is wonderful to be able to open up and talk about ourselves to other medalists.
If you want to know how to get a medal, let me know. If you have the medal, and want to join the group on Facebook, I can give you the steps for that.
It seems to me that the reluctance of Medicare to cover a cgm is due to the extreme high cost. How can the people responsible for the high cost and those who make the decision not to cover the cgm live with themselves when they know they are responsible for the deaths of thousands of type 1 men and women and children. Add to that, the emotional and financial cost to the family. Our government steals from Social Security every day, and then spends that money on everything from pork barrels to cost overruns of contractors to aid for corrupt foreign governments. Americans need to change the criteria for the people we elect to congressâŚ
Cost is a factor with the pending legislation because the majority in Congress want to be sure that laws with expenditures attached are âbudget neutralâ at a minimum.
Cost is not a factor for CMS (Medicare) deciding on CGM coverage under the current law. The law, as interpreted by CMS, says that CGMs are NOT covered, period.
The written law is not that specific. It never says that CGMâs are not covered. It is CMS or its contractorâs interpretation of the law that says they are not covered. If you read the Federal Eastern District Court of Wisconson decision on Whitcomb v Burwell(Secretary of Health and Human Services), you can see this. Ms. Whitcomb won her Federal District Court case. Despite citing her case as precedent at numerous of my MAC appeals, the MAC ruled in favor of the AdQIC(contractor), forcing me to the 5th level of appeal, knowing full well that most cannot afford to go to Federal court.
Yep, we are saying the same thing here @SueL.
I just find it sad and maddening that the MAC is making these rulings that not only invalidate the ALJ process and effectively makes them a waste of time and money (both for you and the broader taxpayer community). IMO, this is the type of result that makes people believe that our government is ineffective and unresponsive to all but the rich.
I know someone had to have said this somewhere, but you also know medicare thinks that type 1âs only need to check 3 times a day. So Golly, if you check 3 times a day, Why do you need a cgm???
(Sorry but I had to make my comment at medicare) every 6 months I have to prove that I need to check more than 3 times a day.
While Medicare is seriously out of whack with its strip rationing, itâs smart enough to allow exceptions. Medicare covers me with 14 strips per day.
Oh, I have been a type 1 for 37 years, and hypoglycemia can cause seizures. I donât usually feel unti 40âs.
Medicare is allowing me 8 strips per day. I pick up 200 FreeStyle strips at my local drugstore every 23 days, with no copay required. I test 12-15 times per day, so I use Walmartâs Relion Confirm meter for the rest of my testing. The Relion meter is very good, and agrees very closely with my FreeStyle meter. The Relion meter and strips are very reasonably priced.
Scottyd, when my BG drops fast, my body does not get a chance to adjust, so I feel the lows when I hit the 70âs. If I drop slowly, my body does have time to adjust, and I do not feel the low until I am in the low 50âs, or the high 40âs. That is why it is important to use a CGM, which enables us to see the lows as they develop, before they are a real problem.