DIABETES & MEDICARE GUIDELINES FOR TESTING BG, ETC...
Are you wondering what they are, cause so am I. Your post doesn't say. I'm worried about them not paying for my testing 10 times a day! I'm already preparing to lose my Dexcom AND my Omnipod pump and am already angry about it.
MEDICARE IS NOT MY MD...WHAT DO THEY KNOW ABOUT WHY & HOW MANY TIMES I NEED TO TEST...I'VE HAD T1 FOR 75 YEARS,I USE A PUMP, & I KNOW MY BODY BETTER THAN ANYONE ELSE.I ALSO DON'T FEEL WHEN I'M TOO LOW OR TOO HIGH.THEY ALSO DON'T COVER CGMS WHICH WOULD HELP.
I know, can't figure out why they don't cover the Omnipod, it's so frustrating how may insurers don't! I have had to submit a letter from my Dr. stating that I need to test 10X a day and it has so far, sufficed and I've been covered. Now, though, my new insurance follows medicare guidelines and they are requiring tests proving I'm type 1 and a log of testing every 6 months!! Very frustrating. I agree, I've been doing this for 36 years and as a result of testing 8 to 10 times a day, I have no side effects. They all talk about "preventative" but when it comes down to covering it - forget it.
I also can't feel lows and currently insurance covers my Dexcom. While it's not perfect it wakes me up at night and has prevented several extreme lows. It can get into the 20's and I feel fine. (or so my brain thinks)
WE ALL HAVE TO FIGHT MEDICARE TO MAKE THEM FEEL WHAT IT FEELS LIKE WHEN YOU HAVE HYPO-UNAWARENESS,ETC...& WHY WE NEED TO TEST SO MUCH.LET THEM FEEL WHAT WE FEEL...OR DON'T FEEL...AFTER SO MANY YEARS WITH DIABETES.
Did I read that right??? You've had T1 for 75 years?? That is AWESOME!! Sorry, I know unrelated to your question, but I saw that and it made me so, so happy!
My understanding (from reading things here) is that Medicare will cover pumps if your c-peptide test confirms that you are not producing sufficient amounts of insulin. So you should be ok there. I think that Medicare does limit test strips (why, I have no idea!)
Isn't there something all of us can do to try and get Medicare to change their coverage decision on test strips? It seems absurd that something that actually prevents complications and additional costs (being able to test your blood sugar levels) isn't fully covered by Medicare and other insurance companies? I have BCBS and am limited to 8 strips per day. In reality, I test upwards of 14 times per day, depending on how many times I get behind the wheel of a car or just feel funny. As a T1, I can't dose properly for insulin before meals unless I know what my BG is.
The one good thing is that Walmart just came out with their inexpensive meter and test strips. I am going to pick up a meter and test strips from them this weekend to supplement my one touch test stips that are more expensive.
I ALSO TEST UP TO 14 TIMES DAILY DEPENDING ON WHATEVER...YOU NAME IT...ETC...IT SEEMS ONLY WE DIABETICS UNDERSTAND THAT.GLAD MY 75 YEARS MAKE YOU HAPPY :).
MBP, can't your doctor do an override on the amount of strips? I also have Anthem Blue Cross and my old doctor just did that and I got 10 with no problem. When I changed doctors I just told my new doctor 10 and there was no problem with my getting the 900 for 90 days.
The # of test strips is likely "linked" to the amount of support taxpayers are willing to give public health which, at this time, doesn't seem to be a whole lot? Adding to benefits provided by Medicare doesn't seem to be on anyone's platform, although if I had to guess which team would be more likely than the other to perhaps move in a positive direction, it's not too hard?
I am also impressed with your longetivity compared to my 53 years which is also a long time. I looked at your profile and see you're from NY so it must be in the water. My experience with Medicare in my opinion they treat T1 and T2s the same. Before I started on Medicare I was seeing my Endo every six months but when I started with Medicare they said I had to see him every three months. My Endo asked why and I told him what Medicare says. Also as someone mentioned every six months we have to justify why I need 22 boxes of strips every three months. I stopped keeping a log book years ago< I just enter my numbers in my pump and when they want a log I download the info into my puter and send it to them. I learned long ago not to let the bumps in the road upset me just learn how to get over and keep on stepping.
this is why i don't drive. i am fortunate enough to get 300 strips a month from medicare, a cgm would be most welcome but that won't happen.
We tried that. They rejected it, saying that they only covered 8/month. I called and they said that I could write an appeal, but to be honest, it was just more work than I had time for. I am thankfully able to pay for the additional strips I need out-of-pocket. Irony of all ironies is that they covered a CGMS with no issue; and I ended up deciding it wasn't for me because, among other things, the cost of the sensors didn't seem to justify the mediocre results I got from one. I figured test strips are cheaper in the long run and I can just as easily manage things with test strips and my pump. I may try the override again this year to see if it works. I haven't tried in awhile, just sort of gave up. Incidentally, my coworker, who has a daughter who was just diagnosed with T1, has run into the same issue.
I guess that there are different types of BC coverage; mine is through the state of California. I just don't get how shortsighted they are! Yes, definitely try again but I'm glad at least you can supplement your strips. When I switched my meter to One Touch as it's the remote for my Ping I went from $40 to $100 for three months as it's non-preferred; I try not think about how much I spend on medical stuff because then I'll realize I can't afford it! For me, I think, things will be better when my CalPers combines with Medicare when I'm 65, but I know Medicare is not good news for most people. None of this is easy, but I agree that people like you Shoshanna are an inspiration to us all!