I am hoping you guys can help me out. I have a T2 client who was denied a pump for multiple reasons, there will be no appealing that decision. She asked me if there was any way she could stop having to do so many shots each day since she can’t get a pump, she was frustrated as heck. I suggested asking her endo about the i port. Her doc said that was a great idea for this client. Here is the down side, she had medicaid and it will not pay for them. I called the manufacturer of the i port to see if they had patient assistance, which they do not. I am not having much luck finding other sources of these for her. Anyone got any ideas? She is on a super fixed income and cannot work. I would love to be able to connect her with a resource where she could get these for free or for a reduced price.
I know very little about medicaid and this sort of situation. However, I work in a mental health center and when I have a consumer who needs meds and cannot afford them, there are sometimes indigent medication programs where the consumer can ask for “free samples” of their meds. Maybe contacting the manufacturer of an iport would give you some other options as to where you could look to find affordable treatments.
I also work in a mental health center, small world isn’t it? The manufacturer offers no patient assistance and would only offer 2 sample sets (4 ports, each lasts 3 days max). I spoke to a manager who let me know that they have no agreements with any of the big medical supply houses so any discount or deal would have to be directly from a supply house. I called a couple of the big boys today like EdgePark and they didn’t have any programs or discounts either. I even asked if they offered a discount on direct cash payments like DexCom does for people who pay out of pocket. So far no luck so I am going to make some more calls to other companies tomorrow.
With the caveat that I am probably not licensed to practice law in your jurisdiction, and that this message should not be construed as giving rise to an attorney-client relationship, etc. (in other words, don’t sue me!), if this is a Medicaid denial, you may be able to challenge it in court. In New York, if you could, it would be via an Article 78 proceeding, but the statute of limitations is very short - 4 months, I believe. So if there’s some potential grounds for why Medicaid SHOULD have authorized the pump, but didn’t follow their own rules, your client should seek legal counsel from someone who, unlike me, knows about this stuff.
