Medicare pump rules different than what I was told previous to today

Diabetes Technology Insulin Pumps
1

I had a long chat with CCS Medical, the provider of my replacement pump which will be a 670G.

  1. They said the return period is 30 days from “shipment date to the last day one can request a return”. NOT the 1 year that every person at both Tandem and Medtronic has told me since December of last year, to date.

  2. It will be a refurb; no new pumps are sent and she explained that when the 670G first came out they couldn’t provide them via Medicare because there was no supply of refurbed 670’s so they only could provide the 630. Obviously, that changed over time.

2

I’m confused by this CCS policy. I’ve never secured a pump under Medicare rules, so I have no personal experience. What did they say when you told them you thought that Medicare policy consisted of a 12-month rental period that permitted the user’s ability to terminate the commitment?

Maybe your and my understanding is premised on a manufacturer compliance with Medicare policy and a third party supplier policy as it complies with the underlying Medicare rules.

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3

They said it is paid off over a year. I’ve no idea where the truth lies–just repeating what I was told. Quite frustrating, to say the least. I think I’ll make another call to Medtronic…
[EDIT] Medtronic confirms what CCS Medical told me today, which is quite a departure from what I was told by both Tandem and medtronic, by no less than 4 people beginning in December of last year, through a few weeks ago.

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4

Here is one explanation of how rental works, but not clear on return of pump during first year.

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5

Hi Dave. So I am understanding that if one is on Medicare they do not get a “new” 670G pump?

Are they still short of supply on the 670G so that is why new ones aren’t available to Medicare people?

6

Dave see if you can be connected with the person that serves your state. Here is the number and extension. 18006464633 Ext. 16519.

I have not had good luck with mine representing my state but perhaps you will.

Also is the person you spoke with from the actual Medicare dept. at Medtronic. I find them to be very good in that dept. thus far.

7

Not short supply. they didn’t send anyone a new 670 and waited until there was enough of a supply of refurbs before supplying the 670 to Medicare patients (all according to CCS Medical)

8

the extension I use is 16718 for Casey (at Medtronic).

9

I just don’t get it. Feel dumb. What is CCS Medical? I will look it up. Ok. Looked it up. I sort of understand.

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CCS Medical is a Medtronic subcontractor which handles Medicare covered patients. I worked with them under my old Medicare/ United Healthcare Plan. The sales people are friendly; however, the billing/collection people are very unfriendly and rude.

12

Thank you Don. The people at CCS are rude?
I have a question. My husband got his pump thru his regular insurance company before he was 65.

Now he is 65 and on Medicare. When we get a new pump will he have to go thru this company? Do you happen to know the answer to that question.

We still have a secondary private insurance company.

Thanks so much.

13

I have secondary insurance with Medicare also. Makes no difference. Medtronic doesn’t handle any direct sales to Medicare patients for the pumps (according to today’s convo with CCS Medical). And I know firsthand that Medtronic can provide the supplies for those who already have a pump prior to going on Medicare. And of course, Medtronic being a direct supplier to someone depends on where they live.

14

I searched some documents, and have theory on how this works. MC covers under part B as equipment, and much of other equipment is rented and returned (durable equipment).

The supplier typically provides item, then gets it back after rental (beds, wheelchairs, etc).

But for insulin pumps, they rent for 13 months, and patient and MC make 13 payments, as rent.

If you dont like pump in first 30 days, you probably owe nothing, or just one month payment. You send back and someone else rents it.

If you return during next 12 months, you probably owe rent for each month used. If pump breaks during this rental period, the supplier exchanges a replacement to you.

After 13 months, you own the pump. If it breaks in the next 4 years, it is covered by pump company warranty.

(The link in my previous post supports this.)

15

That’s not what CCS Medical claims. They said that after 30 days, if you do return the pump you cannot get ANY other pump for the next 5 years. I immediately called Medtronic and spoke to the person who handles the Medicare pump orders. She corroborated what CCS Medical said. They both said that 1) Medicare pays off the pump in 13 months, and 2) after 30 days you either keep it or lose out on having a pump. BOTH similar statements today run totally counter to what both Medtronic and Tandem told me last December and ALSO a few weeks ago. AARGH!

It’s a good thing I use Finasteride or all my hair would be missing from tearing it out. LOL!

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16

Pumps returned to CCS Medical have to be sent to Medtronic for complete tear-down/inspection per FDA requirements. I’ve had no less than 5 refurbed pumps since the 1990’s and it has been impossible to notice any difference from a new one. I can’t speak for other pump brands.

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17

Good info.

18

Medicare does not cover the Guardian 3 Sensors.

Our secondary insurance company covered them and then once my husband got on Medicare they would not cover them because Medicare does not.

We are appealing with both Medicare and our secondary insurance company.

We will see how it goes.

We have done all we can.

19

It doesn’t matter, believe me.

Though all of this was recorded the people that initially told you this will not be corrected and they will do nothing for you.

Have nothing positive to say about the lack of continuity of what one will say as opposed to another when you call. It’s hit or miss.

20

It comes down to what is in the rental agreement, and that may vary by supplier.

21

Seven years ago When I first went on the Medtronic Revel Pump, I negotiated with Medtronic but because I was using Medicare, I was referred to CCS Medical to place the order.

At the time and up until two years ago, my insurance was Medicare with United Healthcare as supplemental. United Healthcare covered the Sensors. However, when my insurance was switched to United Healthcare Medicare Group Advantage, my sensors were no longer covered.

I now purchase my pump supplies direct from Medtronic which is more responsive and efficient than CCS Medical.