So I switched from CalPers to CalPers Medicare as of the first of November. I didn't really think it would make too much difference but the grim differences have started to emerge. I was told today that the doctor couldn't approve the 900 test strips I usually get for 3 months. They made me an appointment to discuss having him write an override letter, but I'm not optimistic. So those of you Type 1's with Medicare, how many are you allowed? I'm almost scared to ask!
Hi Zoe,
I'm sorry about this :( Is your doc the one who is doing this or the insurance? If it is the doctor I would switch doctors asap.
I have heard other people here say that they provided records of bg testing and a letter from the doc and that was enough for them to get the number of strips they needed- they said they got the average number that way, so I would test a little more for the records you give them if it is needed to get an average close to what you really need. I hope this gets worked out asap.
Meee, are you talking about Medicare or regular insurance? You look way too young to know about Medicare! I had no problem with my regular insurance; awhile ago my doctor wrote an override letter and it was accepted with no problem. I've never had to show anyone testing records. But Medicare is a whole new thing for me. I have Medicare which is automatically integrated with my regular insurance so I thought it would be better, but it seems like I still come under Medicare regulations which is what I'm trying to find out about.
Hi Zoe, I'm not on medicare but my father is. But I saw someone's post here a few months ago about test strips and medicare and they said they had their doctor write a letter and they had to provide logs of their testing, that way they were able to get an average number of their daily test strips on medicare. I don't know if that will work for you but I hope so :) I think there are ways to get around the crazy medicare number of test strips for sure.
Thanks for clarifying that you were, in fact, talking about Medicare! I have an appointment with my doctor on the 20th to discuss writing a letter. I'll bring my log book (and my pump, of course, which keeps records!). I've never shown anyone any numbers at all; the most accountability I've ever had was being asked to do an A1C. I'm spoiled.
Zoe, here is the one of the posts: read sdkates reply.. someone else said the same thing but I can't find that one:
https://forum.tudiabetes.org/topics/dealing-with-medicare-limita...
Yes, this is where it pays off to have good records which a pump will- so it's great that you do! Good luck with it, saying a prayer for you :)
I would test more for the next couple of weeks too!
Thanks for including this link, meee. To make it more complicated I don't have the standard Medicare and Medicare supplement. I have CalPers (state retirement insurance) which integrates with Medicare. So the experience of others might be the same as mine or might be different which is why I haven't been paying that close attention to posts in preparation for this upcoming birthday! But the general principal seems clear. I don't pay much attention to my pump records except to check averages occasionally, but I do keep old school log records automatically every day. Hope they (whoever "they" are) can read them! My PA sees a lot of people on Medicaid but that may be different than Medicare. Thanks again.
You're welcome Zoe, I think the records will show that you need those test strips, even if Calpers is slightly different and your doc should back you up too :) That is good you keep logs, I was doing that but it was too much but fortunately everything goes into my phone now and I keep pretty detailed logs there too with tags etc. It has saved me a few times I'm sure.
ps. I'm sure they will muddle through your handwriting too!
I have a Kaiser Medicare Advantage plan & I get 900 strips for 3 months, the Endo wrote the prescription that way & there has never been any question. I also have zero co-pay. So it probably depends on the Medicare plan. I imagine CalPers Medicare is an Advantage Plan.
No, It's not called an Advantage plan, because it's not an HMO it's a PPO, and is an integration between my regular CalPers (Anthem) insurance and Medicare. I'll have no co=pay for doctors, tests, hospitalization, DME, etc,and no deductables, but I think my meds will stay pretty much the same. But I don't know what the cost for my Insulin and Test Strips will be as they are covered on Part B. (I just looked it up and Test Strips ("Diabetes Supplies" says "no charge if approved by Medicare". Yay! Now I just need to get the amount approved.
But I feel encouraged to hear that you get 900 strips for 3 months which is what I'm used to getting as well, so hopefully I will be able to continue that. The doctor wasn't available but he told the nurse to tell me the amount was declined. I had her ask him about a letter and he suggested I make an appointment for us to talk about that, so hopefully he will write one and they will agree to it. I'm horrified at the thought of being limited to 3-4 test strips a day. (I'd buy more on EBay but really can't afford it!) Thanks for responding.
Usually medicare requires a copy of at least a months log, with the average number of times you test on it (if you download a meter theres usually a summary sheet available... its important)..This is common for both T1 and T2 diabetics on Medicare.. It is accountability.. they want to not give you any extra strips than what you use, they are afraid people will sell or give away the surplus... Usually approve it if your logs are complete...and you periodically will have to submit a months log (usually yearly) to re-new the override quantity
Thanks, Jake; this will officially be the first time anyone has ever asked for my logs! Will someone from Medicare contact me or will it all go through my doctor? Do they still need the letter from the doctor to support the "override"?
I was actually excited about starting Medicare; four days in, the excitement has officially worn off..lol
good luck Zoe. Been there - done that for the last few years.
so alarming. i cant offer any advice but can wish you luck and as little hassle as posible in getting all you need to take care of the D!
Thanks jims and pancreas; I'll let you know how it goes.