so you're trying to make a case, i get that. T1D, T2D and Type Lloyd.
You're not telling me anything that i don't already know as a D for 2/3 of my life.
But, I get it now. Since you stated the other day that you haven't seen your endo in 10 years, you have diagnosed yourself as different from all of us.
Yes, kathimc
Lloyd, I hope you will find a way to continue to use it.
ok wait many of us have to deal with medicare and so far we've survived. this u have to get used to...things are different from private insurance but u HAVE to be willing to go with the flow
I've seen my endo once in 10 years. It is a 300 mile round trip, and my NP does a good job.
-Lloyd
Josh is correct. You're still getting treatment. With World Diabetes Day just last week, it seems you've forgotten how many people do not get the supplies they need to survive.
i need to see my endo every 3 months for medicare to cover the pump
& supplies
Yes, and I will need to also Shosh, if I can get pump coverage.
-Lloyd
that is a nessity to see the dr every 3 months if u wanna keep the pump …also if u haven’t seen ur dr for 10 years how do u know what u need???
I have not seen an endo for 5 years. I see my doctor every 3 months. I have been getting good results doing this.
See, so you ARE different from all of us. We have to follow the rules....you create your own.
No, there are no rules by my current insurance company, that require me to go to an endo.
They "allow" me to go to an endo once a year.
that's irresposible
well all i can say to that comment is welcome to medicare Lloyd
My A1c has been in the 5's for 7 1/2 years. I went to an endo once to see if there was anything useful that I was missing. He put me on vit D3. He had nothing to add as far as my diabetes treatment.
It is not standard practice for a t2 to see an endo unless they are on insulin and having problems. There is a shortage of endos.
I must be missing something here. Why is it so difficult to accept that someone wants to keep doing (in this case, using the pump) what has worked for him or her. I believe all Lloyd has been doing is venting his frustration with the situation. He is not staking himself out as special or unwilling to do whatever he needs to do once he goes on Medicare.
280.14 – Infusion Pumps
(Rev. 173, Issued: 09-04-14, Effective: Upon Implementation: of ICD-10, Implementation: Upon Implementation of ICD-10)
A. General
Infusion pumps are medical devices used to deliver solutions containing parenteral drugs
under pressure at a regulated flow rate.
B. Nationally Covered Indications
The following indications for treatment using infusion pumps are covered under Medicare:
1. External Infusion Pumps
a. Iron Poisoning (Effective for Services Performed On or After September 26, 1984)
When used in the administration of deferoxamine for the treatment of acute iron poisoning and iron overload, only external infusion pumps are covered.
b. Thromboembolic Disease (Effective for Services Performed On or After September 26, 1984)
When used in the administration of heparin for the treatment of thromboembolic disease and/or pulmonary embolism, only external infusion pumps used in an institutional setting are covered.
c. Chemotherapy for Liver Cancer (Effective for Services Performed On or After January 29, 1985)
The external chemotherapy infusion pump is covered when used in the treatment of primary hepatocellular carcinoma or colorectal cancer where this disease is unresectable; OR, where the patient refuses surgical excision of the tumor.
d. Morphine for Intractable Cancer Pain (Effective for Services Performed On or After April 22, 1985)
Morphine infusion via an external infusion pump is covered when used in the treatment of intractable pain caused by cancer (in either an inpatient or outpatient setting, including a hospice).
e. Continuous Subcutaneous Insulin Infusion (CSII) Pumps (Effective for Services Performed On or after December 17, 2004)
Continuous subcutaneous insulin infusion (CSII) and related drugs/supplies are covered as medically reasonable and necessary in the home setting for the treatment of diabetic patients who: (1) either meet the updated fasting C-Peptide testing requirement, or, are beta cell autoantibody positive; and, (2) satisfy the remaining criteria for insulin pump therapy as described below. Patients must meet either Criterion A or B as follows:
Criterion A: The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin doses for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen:
• Glycosylated hemoglobin level (HbAlc) >7.0%;
• History of recurring hypoglycemia;
• Wide fluctuations in blood glucose before mealtime;
• Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl; or,
• History of severe glycemic excursions.
Criterion B: The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least 4 times per day during the month prior to Medicare enrollment.
General CSII Criteria
In addition to meeting Criterion A or B above, the following general requirements must be met:
The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement, or, as an alternative, must be beta cell autoantibody positive.
Updated fasting C-peptide testing requirement:
• Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110% of the lower limit of normal of the laboratory’s measurement method.
• For patients with renal insufficiency and creatinine clearance (actual or calculated from age, gender, weight, and serum creatinine) ≤50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200% of the lower limit of normal of the laboratory’s measurement method.
• Fasting C-peptide levels will only be considered valid with a concurrently obtained fasting glucose ≤225 mg/dL.
• Levels only need to be documented once in the medical records.
Continued coverage of the insulin pump would require that the patient be seen and
evaluated by the treating physician at least every 3 months.
The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators, and dietitians who are knowledgeable in the use of CSII.
I agree - my PCP was more than happy to treat my D - even on insulin - until he and I decided that there were too many questions that were not being answered. At that point, I was referred to an endo. I am now on my third endo - the first two were left with questions that remain unanswered; the third one just says that I'm "interesting" and admits that that is not helpful. My third endo, however, did recommend a pump and, despite with my insurance, so far, I am slowly getting better results - We shall see.
I do not know many other T2's locally that see endo's regularly, if at all.
is there a way to skew a cPeptide test to give favorable results to qualify for CGM or pump under meducare? i will welcome any advice…i badly need CGM and hope my testing shows this need…thanks my Dpals