Medicare/Tandem Patients


#1

I was on the phone with Tandem’s tech support this morning to find out why my pump only vibrates without an audible alert when I cross my low threshold setting. My iPhone does not do this, it makes a very loud audible alert anytime a threshold is crossed or I need to do something with the system, with a calibration being the only exception. The tech support person and I got into the Medicare rule subject because I was curious if Tandem was going to be affected. He told me that Medicare is now forcing Tandem to tell their patients that they CANNOT integrate their pumps with the G5. How’s that for progress, folks?


#2

@Jason99 - Call me skeptical but I never take on faith the word of anybody without some kind of confirmation. It is not unusual for me to call back and talk to a different tech support person and really dig into it and find out if they will change their story. Or speak with a manager.

In this case, what you were told simply is not backed up by what Medicare has published. I flat out do not believe the information which the Tandem Support told you is accurate.

As per the actual wording (below), the restriction is very specifically on “smart devices” which have examples listed. An insulin pump clearly is NOT a “smart device”. Further, the Medicare decision says that supplies used with “non-covered equipment” are themselves not covered. However the Tandem t:slim X2 pump clearly is DME and is covered equipment.

Based on this, my conclusion is the Tandem Support person was providing completely inaccurate information.

From the actual decision (which I do not believe has been superseded - yet).
“The Medicare DME Benefit excludes coverage for non-medical items, even when the items may be used to serve a medical purpose. As a result, smart devices (smart phones, tablets, personal computers, etc.) are non-covered by Medicare under this exclusion. Likewise, medical supplies used with non-covered equipment are not eligible for Medicare reimbursement.”

https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/coding-and-coverage-therapeutic-continuous-glucose-monitors


#3

@Jason99 - So to get the the actual technical issue you were calling Tandem about.

Starting on page 191 of the new User Guide for the Tandem t:slim X2 with the G5 update (link for the manual included in the confirmation email you received from Tandem after the upgrade was completed) covers the “CGM Settings”.

The “fixed low alert at 55 mg/dL” is the only alert which you can not override to vibrate only. This is fixed at a vibration first followed by beep 5 minutes later if not confirmed.

You have “CGM Volume options” for the user set alerts such as High, Low, Rise, Fall, Out of Range and “Other” alerts. The “Fixed Low” very specifically does not adhere to the “CGM Volume” change.

So for the “Low Alert” which I believe you called Tandem about (and to which they SHOULD have addressed).

The first question is what is your “Low Alert” set to (which BG number) as well, what is your overall “CGM Volume” set to?

On page 194 it gives the expected response of the pump for the Low Alert depending on what you have for the CGM Volume:

(Low Alert) Vibrate: 3 short vibrates
(Low Alert) Soft: 3 short vibrates + 3 low beeps
(Low Alert) Normal: 3 short vibrates + 3 medium beeps
(Low Alert) HypoRepeat: 3 short vibrates + 3 medium beeps [same as normal??? odd…]

So the Tandem Support Rep should have determined if the pump is working as per the Manual or if something is actually wrong with the pump. But it is always possible to get a Support person who is new or perhaps not as well trained as some of the more experienced staff.


#4

Tim- yes, he and I went through all my alert settings both in the pump section, and the CGM portion. Both, were set to have audible alerts. My pump volumes are all set to high, except for the key press, which is set to medium. My CGM volume is set to HypoAlert, with my low threshold at 90, my high at 180. I noticed that the Dex receiver also does not give an audible alert, it just vibrates. I’ve had the receiver side by side with my iPhone when I fell below my 90 threshold. The iPhone screamed like a banshee, where the receiver just vibrated. I called Dexcom about this, I was told this is a hardwired setting that cannot be overwritten. The receiver is programmed to vibrate first, if no action is taken to clear the alert after 5 minutes, it then starts to make noise. It seems Tandem just took all of Dexcom’s software and put it in their pump. I do not like this setting, I think it’s very dangerous. If I was forced to just use the receiver, I’d be very worried about this. 5 minutes can make a difference between being able to address a low and being in a coma, or in my case a seizure.

I didn’t have a long conversation with the tech about the Medicare rule. I was surprised to hear this, I had a feeling it was coming. He even put me on hold to talk to his supervisor. Two people in that building are saying this now. If this is true, the ramifications from this ruling are going to affect a lot of people with this technology. The only analogy I can think of is, Medicare is paying for you to have a hammer and nails to build your house, but they are restricting you from hitting the nail with the hammer. Sorry, best I can do


#5

Two different statements. Not to quibble, but it is really not fair to say the “receiver does not give an audible alert, it just vibrates” if the actual action is that it actually does vibrate first and then is followed by an audible alert if no action is taken after the vibrate.

This does not in any way discount your follow-up statement about the 5 minutes being too long. That is a valid discussion. But the initial point would be whether the hardware is working as intended. If in fact it truly was only vibrating and not giving an alert at all - then that would be a malfunction.

What Tandem is saying about Medicare is completely False. Until such point as something comes out from Medicare saying this - I will stick to this point. False. Next time you speak with Tandem on this subject, ask for them to send you something (anything) in writing which backs up this position. It would have to be something new as the current Medicare information absolutely does not say this.

Whether you CHOOSE to use the Dexcom Receiver or the Tandem t:slim X2 (as the receiver) is an entirely different discussions. But from a Medicare perspective - is YOUR CHOICE. The Medicare decision only addresses Smart Devices (and non-covered equipment) of which this Tandem pump clearly is not.


#6

I agree with everything you said in regards to Medicare. I’m assuming Tandem had to have a discussion about this internally. If they are in fact following a company directive to tell their Medicare patients that they can’t integrate their X2 with the G5, they should have given advanced notice to their patients in written form. If the ruling specifically says pumps or any other products classified as DME are exempt, then Tandem needs to get their facts strait. Let’s wait for Laddie to weigh in on this. She seems to know about this issue more than anyone, and she’s on Medicare with an X2 paired to the Dex. No disrespect to you Tim, I highly value your opinions.

No, not a malfunction at all. I was hoping Tandem would build the CGM software from the ground up and not incorporate this 5 minute window of silence into the X2. I have had a number of conversations with Dexcom about this feature in the past. They told me it was put into the G5 because a number of their patients were complaining that the G4 alerts could not be silenced. This is their solution, which I feel is very dangerous and foolish. How they got this by the FDA is a complete mystery to me. Even as I write this, my pump is vibrating on my waistband and my iPhone is interrupting my typing with visual and audible alerts because I’m at 89 right now.


#7

You got no arguments with me there. Actually I already asked @Laddie !!! I had the same thoughts on that as you did.
:stuck_out_tongue:


#8

What was her response?


#9

@Jason99 - Aside from it being your CHOICE as to use the pump or receiver for your cgm numbers, my concern would be can you upload the data to your preferred application (local or cloud) so as to be able to analyze your numbers? Without such, you would have reduced benefit from the cgm.

I have not tried to upload the Tandem t:slim X2 with the G5 update and with cgm data while at the same time NOT having said cgm data already uploaded to Clarity via the Dexcom App running on a Smart Phone. Have you tried this yet? If so perhaps you could post whether you had success or failure or any other difficulties or perhaps it was just smooth and working great?

I have tried to do the similar upload into diasend and the cgm data did NOT transfer. I have opened a support ticket with Diasend. Whether this results in the cgm data being able to upload or not - we will have to wait and see.

But if the cgm data is not able to move from the pump to any application to manage such and if no smart devices are in use to allow such upload then I would seriously question if it is worth using the pump for the cgm as opposed to the Dexcom Receiver.


#10

I found her reply as above.


#11

And as FYI - If you have already applied the G5 update to your X2 but decide you want to switch back to your Dexcom Receiver, it is no big deal to switch back. It is not necessary to “uninstall” the update from the pump or anything. Just change the Dexcom G5 transmitter ID on the pump to something bogus that (more or less) fits the format like “400000” or something like that.
You can then get the Receiver hooked back up to the transmitter.
24 hours after the pump has been used for CGM, you would get a minor X2 alert and the pump main screen would revert back to the pre-cgm update.

And then later if you want to switch back to the pump for cgm - you can do that as well. So you are not “locked in” to the update and can move back and forth. This actually is nice so you can try them both out and decide what works best for your particular situation.


#12

I haven’t used my receiver for months now. When I first got the G5, I used my iPhone and receiver because I didn’t trust the iPhone at first. After a week, I ditched the receiver and never looked back.

I did have to upload my pump to t:connect the other day while on the phone with tech support, so they could look at my battery usage. I had no problems with this process, my CGM data synced flawlessly with the Tandem software. I will say that the T:connect is not even in the same ballpark as Clarity. The reports are not as good, I had a hard time navigating my way through it. Clarity’s design is just brilliant. I love having clarity on my phone, and having it upload all my data automatically to Dexcom.

I hope Laddie’s and your analysis of this Medicare stuff is correct. I find it odd that Tandem employees are giving false information to their patients. They are a relatively small company, I would think everyone is on the same page.


#13

Tandem really doesn’t have a dog in this race. (Horse in this fight? lol) The proper response for them should be for the patient to contact Dexcom. The bottom line is Tandem can actually say anything they want and there are no consequences to Tandem whether they are providing correct or incorrect information as far as Medicare goes.

As Dexcom receives the reimbursement from Medicare for patients using the G5 system, it is important for Dexcom to know the real rules and convey the proper information. Dexcom has clearly spent a great deal of effort in the recent months on the entire Medicare situation and I would entirely expect for Dexcom to be providing accurate information.


#14

Tim- have they even begun to tackle every state’s Medicaid program? They have barely finished with Medicare. I would expect Medicaid to be far more complicated as they have to negotiate with 50 different entities.


#15

My bad. I sometimes say Medicaid when I mean Medicare or vice-versa. I think my brain looks at the first three letters of a word sometimes and just stops.

Blarg.

Thanks for the catch. Gonna go back and edit my post now.

:open_mouth:


#16

My phone auto corrects the word to into do for some reason now.


#17

My guess is that it is currently correct that only the Dexcom receiver can be used. Although I wish that it were otherwise, I suspect that Tandem will have to apply to Medicare to be able to use the X2 as a Dexcom receiver.

Fortunately I have several months of Dexcom supplies before I have to purchase them through Medicare. Whatever the policy is, I will deal with it. And if I don’t follow the guidelines, I will keep quiet about it on social media. :grinning:


#18

There’s no way Dexcom or Medicare will know if you’re using the X2 instead of that crappy receiver. Unless Medicare enacts another stupid rule like having to provide a copy of your Clarity reports or Tandem’s T:connect, I think your safe. But, again this situation seems to be getting worse rather than better so who knows what they’ll come up with next.


#19

Well - that is another issue.

If somebody is only using the X2 for cgm data, and not also using a Smart Device then there is no obvious way to get data into Clarity. Currently the Dexcom Clarity device uploader to which you can connect your Dexcom Receiver via USB and upload the cgm data - is NOT compatible with the X2 pump. You can not upload cgm data from the X2 into Clarity.

I would suggest anybody who might have the slightest issue to call Dexcom Technical Support and ask that a Support Ticket be opened requesting the Dexcom Clarity device uploader be made compatible so as to be able to upload the cgm data from the X2 pump.

Nothing wrong with attacking all issues on all fronts. Ask for change. The more tickets opened requesting change and fixes, the more likely these things will be prioritized.


#20

This Medicare BS makes me tired. I am sorry, but unless you are asking to buy a smart phone why does Medicare care what you receive it on. I do not want Medicare buying cell phones, but who gives a rats behind if someone can see data on a phone or their forehead if that works. It makes so little sense.