Medicare: pump supplies refused for C-peptide score?

When I aged into Medicare, I failed the c-peptide test the first time because I happened to be high when it was taken. My doctor told me to come back and retake the test when my bg was below 100, which I did and passed. (He didn’t submit the first test.) Apparently if you produce any endogenous insulin at all, a high bg will make the c-peptide go higher. I’m guessing that Medicare thinks you’re not insulin-dependent in that case and don’t need a pump? Who knows. I’m pretty sure these rules aren’t being made by actual endocrinologists.

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@jgbar1950 Interesting. That would be pretty ridiculous, but our government works in the weirdest ways sometimes. I could maybe see a test when you go on a pump or first sign up, but every year? I know they seem dead set against type 2’s even on insulin getting a pump. So I assume it’s a cost issue to rule out type 2’s.

I did call Medicare about it and the rep contacted their research department and they said they couldn’t find anything about a C-Peptide test being required every year for a type 1. That of course doesn’t mean it’s not true, but I am on an Omnipod anyways, which seems to be classed differently. I do not have the every 3 month visit requirement. Just every 6 months for the CGM. I do know my previous not making insulin C-peptide and positive antibody test was accepted when I first signed up for Medicare to qualify as a type 1. I’ll find out I guess if in my particular situation, if that requirement changes

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Just got my fasting c-peptide result: 0.8, at a fasting BG of 125.

Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory’s measurement method.

I read that as saying anything < 1.21 meets the criteria, since the lower limit is defined as 1.1 ng/mL So whoopee, I’m a type one diabetic, who knew.

Thanks all for the comments and advice. I hate to be such a wuss about this but that old 1.8 ng/mL result on my chart has been making me anxious about having to clear this stupid hurdle for years. Not turning handsprings—having to “prove” I have this condition after dealing with it for four decades still feels demeaning. But at least that’s one worry I can check off my list.

Gonna celebrate by pumping a sh**-load of insulin and eating a nice high-carb dinner.

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And worst of all, who knows if this is even true. These guys seem quite capable of getting flummoxed by their own policies. When I was trying to figure out how to get my pump insulin covered under Part B, I kept getting asked when I’d purchased my pump because, as several agents told me, Medicare would only cover the insulin for it as DME if my pump had been purchased through them. Um, no, actually that isn’t true, Near as I could tell, the documentation they were reading was about getting qualified to start pump therapy under Medicare and somehow they were applying that to me as someone already using a pump. Just one of many panics along the way of trying to penetrate the maze of Medicare.

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I feel like the Docs we have in town are less inclined to offer letters of medical necessity. I’m gonna find out what a C-peptide is and how DrBB can be declared, ‘not a diabetic,’ because THAT’s really interesting.

Congratulations on being a diabetic again, @DrBB! Glad your back.

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I’m so glad that you got this straightened out, DrBB, but wow, this sounds like a nightmare!!

@mohe0001

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My c peptide has always been zero. But some type 1 still have some insulin production. If you want to drive it down you can take extra insulin to drive your sugar lower like in the 80s and don’t eat anything.
Then your islet cells will stop producing. Maybe fast 12 hours.

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Your body first makes “pro-insulin” chain, which has A,B,C portion. This is precurser to being insulin. When the c-peptide is removed, the remaining portion now is active insulin. A low C-peptide indicates low or no insulin being produced.

More details here.

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Pretty much what I did, yes. Checked a fingerstick just before leaving and I was at 100, so I figured that was probably good enough, though by the time I was in the chair for the blood draw it had gone up to 125. Dunno why. But the c-p result was good enough to pass the stupid Medicare hurdle, so I’ll take it.

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I too had decided , that I was going to get a pump so that I could get tighter control on my glucose levels , as I only bonus dose.
I first issue in looking for a pump was the one available at the time they all required more insulin on board then I would have used in a three day period . Which would have been wasted. Along comes tslim . Then to find out Medicare would not pay for a pump because of my Cpeptide level . My only recourse was to pay upfront for a pump.

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I’m so sorry. Insurance consistently makes it impossible to live well with diabetes!!! What I really want to know, is if insurance companies place this much burden and patience with other types of diseases! I mean, do they give patients that need colostomy bags this hard of a time??? or pacemakers??? or wheelchairs? Or are diabetics singled out for particularly harsh ridiculous proofs to get the insulins, medication, and supplies they need. I really do wonder.:face_with_monocle: I’m not even asking for my stuff to be free. I just want to be able to get it. Period. Without the process taking years off my life for the stress involved.

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This won’t make you feel any better, but I have had to be re-tested everytime my employer contracted with a new health plan provider. It made my HCP’s angry - “WTF?!?! Is my board certification meaningless?”

I often liken health plan business like the home mortgage business. The bank issuing the mortgage doesn’t give a damn if you can’t truly afford the loan (like you used an unusually high overtime payment period when applying) Since mortgages (like health plans) are “sold” to too others it isn’t their problem for long. A current health plan figures that if they deny necessary Rx’s etc and you go downhill, but the time the costs go up - it’s another health plan (or ill-health plan) problem

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contents removed by original author

If you don’t like my responses, that’s your right, but if you’re going to criticize me, please indicate how I am violating the policies of the forum. Without rudeness.

The OP posted as havingT1D…Onc you’ve documented T1D with the C peptide test for Medicare youll never have to requalify with Medicare again.which is the question I was responding to that you criticized. That will continue to be true until the promised cure “that isj always 10 years away” is actually found and made available to Medicare patients. To deal with idiot Medicare providers or any other insurer keep a copy of your medical records.

A fasting blood glucose test does not have to be done first thing in the morning. Understanding that is the key to passing this test for Medicare.

Any person with T1D should be able to take insulin for one last meal, and let their blood glucose drop until it’s low enough for Medicare. Just wait without eating and no matter how high it is to begin with, your blood glucose level will eventually drop.

It’s that simple, and what I did to get numbers that Medicare approved.

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