Ok, thank you
1 Like
Hi Lori.
When we both went on Medicare in January 2019 We kept with my husbandâs insurance company that he had before he retired.
They assured us all that was covered would continue to be covered including sensors. Not true.
It was a big mistake and we paid way too much for the insurance and are investigating our options thru a Medigap plan thru Medicare.
We appealed twice and went before a panel for our private insurance company. They still denied. Disgusting.
At the same time we appealed to Medicare and got a Congressman involved. We won because of some very specific wording I believe but we also submitted excellent concise yet comprehensive info to them.
We had ordered sensors at the very beginning of 2019 before Medtronic started their shenanigans. You see they said they would submit to Medicare at the beginning of the year. NOW they wonât even try. If they tried Medicare would deny then you could appeal. Medtronic wonât allow that. They want their money. So we have to fork over the 345 per box. Medicare agreed to pay the 1800 plus dollars from the three boxes we were sent that they bill to the insurance company. If we order more boxes it will be 345. Per box PERIOD.
I notice that amazon has a bunch of the Sensors for sale. And good prices. Take a look. I would go that route and scoop them up. You may get some duds possibly but the price is much more palatable. Medtronic Guardian 3 is the search term or Medtronic Sensors. I find this interesting. Are people bailing on Medtronic I wonder?
My husband recently went to our endocrinologist nurse and she said she is going for training for a new 780 Medtronic pump in January. That info is in the second link I put for you in the initial long email. If that goes then you can trade in your pump and some money and get the new pump and all should be covered by Medicare. Now I am not holding my breath.
Supposedly and I also have this link in the lengthy email above, July 23, Medtronic submitted research done that will hopefully allow Medicare to cover the Guardian 3. When and if it will be approved. Again not holding my breath.
I hope it is ok but I have put the letter from Medicare with the picky wording that got our 1800. Approved and covered. The key word is âtherapeuticâ
One more thing do you would think that since we got approved by Medicare with our appeal we could order more sensors as we won our appeal. Nope. Because it is âcase by case.â
Well if you pay Medtronic out of pocket there is no opportunity to appeal. See what I mean?
Here is my best suggestion which you may take or not.
Buy off Amazon and do it soon.
All else at this pt. calling and wasting your time, energy and frustration and itâs rigged for failure.
Just what they wanted. And it worked.
Buy off Amazon.
Thank you, I do appreciate your input, valuable info out to congressmen and women, but nothing seems to be getting addressed. We the consumers, who needs these devices to stay alive, healthy, and live an active life, should never have to deal with such issues. The Medicare manual stated âCGMâs are coveredâ.
I find that every time I call Medicare I get a different answer. I have come to the age old conclusion that if the government is involved, it will be screwed up!
Thank you again for all of your time, knowledge and for forwarding your appeal approval.
Hopefully the next election will bring forward a âleaderâ who can straighten out this health care system and not continue to destroy it.
Warm regards
Lori
You are so on the same page I am.
Anyplace you call there are only a few people that know the answer and if you do get to them for the most part the compassion is not there. Or they would lose their job.
People may say oh what. Complainer am I?
Well I am fighting for my husbandâs life and his right to have a quality life.
Nothing is going to change because well donât get me going.
Suffice it to say, our politicians are not able to enter our bubble. And the bubble they are in is not where we ever want to be.
At this time Lori you can get on Amazon and buy three boxes of sensors for the price of one.
It will give you peace of mind.
Lori if I hear anything that might be helpful to you concerning this âstuffâI will put in this forum post and direct to you.
âNever give up, for that is just the place and time that the tide will turn.â âHarriet Beecher Stowe
We can never give up helping each other.
I will be in touch!!!
Sally
2 Likes
Thank you again Sally,
I did go on line and purchased a months supply for $115 + $5 Shipping. Much better than Medtronics pricing, and think about it, this seller is making a profit! Thank you for the inside scoop on Amazon, it is appreciated.
Also, If I see anything relevant to this issue, I will be sure and pass it on to you.
Lori
Canât guarantee those will always be there for that pricing but they are right now.
I found my 79 dollar box with shipping on eBay a few months back.
It will give you piece of mind.
If a sensor goes bad of course you canât get a replacement from Medtronic but I think it is worth the price.
If I hear of anything else like I said I will let you know.
I want to add like anything one does not always know about legitimacy of product ordered online but I have never had a problem.
Sally
My husband and I had this conversation about servicing a non working sensor. We felt that if that happened, we might try to call Medtronics as it is their product. We may be shot down after researching lot numbers and reference numbers, but we feel it would be worth a try.
Possibly a waste of time, but we can only hope!
Take care, Lori
I bought a box of five Guardian 3 sensors on Amazon today for $125, including shipping.
Me too. Yesterday. They go quick. Feast or famine.
Are you currently paying $345.00 and appealing with medicare or did you have to pay the full price for the sensors and Medtronic billing Medicare and then appeal.
This has really upset me and I have been challenging this since July 2019.
I have not written to my senator and congressman about this whole ordeal.
I donât quite understand what the problems is. I am on auto mode with my 670G pump 90 per cent of the time.
What can I do to advocate for us.
1 Like
Carolyn have you read the posts that I put on this forum above. They have the answers to your questions.
I am finally getting ready for the day. In Boston from dawn and way past dusk for eye surgery ââstuffâ
for my husband, yesterday. So tiredâŚ
I will put a nutshell and comprehensive email later today for you to sum it up and be crystal clear.
My capital letters are not meant to seem like shouting, only emphasizing.
Carolyn, read the posts carefully above.
It is my understanding that a person has to buy the Guardian 3 Sensors for 345. A box from Medtronic.
THEY will NOT submit to Medicare.
If they did submit a person could appeal to Medicare and win coverage as we did at the BEGINNING of 2019. For 3 boxes.
But NO MORE.
They want their MONEY up front.
Medtronic will NEVER submit the Guardian 3 Sensors to Medicare at this time.
You may choose to keep an eye on Amazon and eBay for bargains on Guardian 3 Sensors. I just got a box in the mail for 125. And the expiration date is 7/20. I bought a box a month ago for 79. On EBay.
Currently as of July 23 after a research study Medtronic submitted the Guardian 3 Sensors to the FDA for approval so Medicare could cover possibly. No news yet.
Also a new Medtronic pump called the 780 is suppose to come out next year and you can trade in with a fee the 670G And all will be covered by Medicare.
Sally, thanks so much for all your info it is so helpful for all of us struggling to figure out what is covered.
I wanted to share a new dilemma we were just made aware of yesterday. Notice was from our Medix supplemental policy (we are on Medicare as of July 2019). The notice states that the deductible from Part B Medicare which covers pump supplies will no longer be covered beginning in jan 2020 for all new Medicare recipients. Anyone presently covered will continue to have their deductibles covered and are grandfathered in. This, I know, will be so devastating for these new Medicare recipients. Not only are we now paying oop for the guardian sensors, but starting January 2020 deductibles for part b pump supplies will no longer be covered for the newly enrolled.
I also just read that Canadian pharmacies and putting an end to supplies of insulin to Americans,!!
Our government is just doing a crackerjack job taking care of the elderly arenât they.
Hi Lori. Not sure what this means exactly? Can you give a clearer explanation?
What do you mean by deductibles and what is Medix please?
Not enough information.
Could you take a picture of your letter without personal stuff and post or message me.
Being a librarian that would be helpful to me.
Thanks Lori.
Lori I have put your post in a new topic for the group to read and comment. More clarity may help all of us.
hi Sally, when on Medicare you have
Medicare A - covers hospital
Medicare B - covers Durable medical goods - pump supplies @ 80%
20% balance is your responsibility this is where you buy into a supplemental policy , ours is blue cross blue shield MEDEX Bronze which has covered the 20% in its entirety.
Then of course you need part D which covers prescription drugs
Also if you need vision, hearing or dental coverageâŚthose are all separate policies you will need to buy into
Once you reach 65 you are mandated to apply for Medicare- it is a journey funneling through all of the policies and coverages. My experience has been that as expensive as it is to carry a policy we find that you eithe pay up front, or you pay co-pays, deductibles etc as you go.
Basically it is a loose loose situation, lots of money pop eithe way!
No advantage, we found the co pays and pop to be to expensive, we have original A& B with supplement Medex and a part D