Anybody here have experience convincing Medicare to cover an insulin pump? I was on a pump for about a year when I was on my wife’s insurance at work, and my blood sugar was so much more well-controlled while I was on it. However, we were forced to drop me from her insurance to save money, and Medicare wouldn’t approve me for a pump since my diabetes wasn’t “bad enough” to need one.
If anyone has any suggestions on how to get started, I would certainly be grateful.
You have to meet certain lab requirments to get a pump on Medicare. I fought for 2 years before they covered mine.
What certain requirements? Is this the same for people with Medicaid?
I’m on Medicare but I’m Type 1 so I had no problems once it was established that I am T1. I’ve heard of people who are Type 2 having problems getting a pump. If you get your doctor to support you regarding how well you did with the pump perhaps they will approve. At times you have to be persistent with what you know is helpful to you. I wish you well. There is a Medicare Rights group that can also be helpful. Here is the address for their website medicarerights.org
I think Medicare requires that your C-peptide be at a certain level or you have GAD antibodies, or both, before they will approve a pump. However, if you have even some GAD antibodies, they’ll approve it even if your C-peptide looks more like that of a T2. I only know this because my brother is one who got a pump approved by medicare because he had a positive GAD antibody test, although it wasn’t enough to be indicative of T1.
Ruth
I have tried without success to get a pump approved instead of the 5 injections per day that i take. they require that you have a c-peptide result of less then .90 in order to qualify, my first test was 1.1, and the second test was 2.0, after that, i just gave up.perhaps later this year, i will get the blood test once again.
Estel,
My brother’s C-peptide was over 3, but he did have some GAD antibodies, so he got approval. I think they took that as a sign that he was either T1 or T1.5. They definitely will not approved pumps for T2’s, which is just plain stupid in my opinion. After all, if you’re a T2 who needs insulin and who can get better results with a pump, it’d be a lot cheaper in the long run to pay for a pump than to pay for treatment of all the potential complications.
Ruth