From the rules posted above:\
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.
It is extremely rare for medicare to approve a CGM. It has been done.
Even though I am T1D, I am in complete sympathy with you, Lloyd. Diabetes, whether T1, T2, or other, is difficult to treat well. The fact that you've successfully controlled your blood glucose level using a pump should count a great deal with getting Medicare to pay for a pump. This is a penny-wise and pound-foolish policy. It needs to be changed as soon as possible. Keeping you engaged with the best possible treatment tools will lead to lower costs in the long run. As a taxpayer, I object to this policy!
Terry i agree with you 100% regardless if you are T1, T2 , OR whatever
why does it have to be approved & by whom?
i am crying for you
I'm so sorry, Lloyd. I start Medicare in February. I'm not insulin dependent yet, but there are weird restrictions for those of us who are T2s with low A1cs without meds. It's like we are being punished for our tight control---severely limiting test strips, for instance, which will speed up our progression to needing meds.
One of many important lessons I learned here at TuD is to not be afraid of needing insulin when the time comes, but I'm not in any rush to get there. For a little while, we'll be able to afford extra strips for me from Walgreen's, but I don't like it either. We know you are not alone. You should continue to seek out kindred spirits, gather together and agitate for change. We did that here in Oregon for Oregon's healthcare reform some time ago.....Good luck!...Judith in Portland....
Someone told me that the lower your blood glucose is at the time of the test, the lower your C-peptide will be. Turned out to be true: I was tested on a morning when I woke up quite high (in the 200's) and my C-Peptide was too high to qualify for the pump. Had it re-taken when my bg was 70, and my C-peptide came out so much lower that I did qualify.
Try getting it tested again when your bg is low (Or, MAKE SURE your BG is low when you have the C-pep test) and then submit that one to Medicare. Worked for me...and I'm a T2 on a pump.
Ruth
I'm really sorry - I hope that you will find a way to get around all of this. You have worked SO HARD to get to some extraordinary numbers with your pump and if you have to start over with MDI, well, it's not easy. Could it be one of those lessons in life to learn to adapt? I really feel for you, Lloyd. Keep us posted.
so, for my upcoming second cPeptide test, i should have a low fasting bc and cpep will follow…i did not have an accurate first test and am required to retest…am trying to figure out the best plan for this…thanks Ruth
Sigh....I hope it all works out Lloyd.
I'm jumping on this thread far later than I would have wished, and I want to thank those of you who have made positive, supportive and constrictive contributions! That is, after all, why this community exists: to support and inform one another. "Out there" in the world people with different types of diabetes are seen and treated differently, but within TuDiabetes we are ALL just people with diabetes, deserving of the utmost compassion, kindness and respect. It is our guiding principal.
Like Lloyd, I use an insulin pump. And, like Lloyd, I feel certain that my blood glucose control would suffer if I switched to MDI. If I was staring at the threat of having my pump taken away I would be incredibly anxious about what that would mean for my health and quality of life going forward. Lloyd, I'm really sorry you're up against this right now. I truly hope your battle to keep pumping will succeed, and that you will find help and support in that battle from your friends here on TuDiabetes.