@Babs5 and @dogdemon
To qualify for an insulin pump through Medicare you have to:
- Be on multiple daily injections (I believe at least three) of insulin
- Be testing your blood sugars an average of 4 times a day for 60 days prior to
obtaining (I have always heard that it had to be 4 times a day exactly everyday but
Medicare’s document on the matter says “average” of 4 times a day) the insulin
pump. (You should have to provide actual glucose logs)
- You have to have seen a diabetic nurse at some point
- You have to have a fasting glucose and C-Peptide lab test (have to be same draw)
Also, preferably, the lab needs to notate on the results that you are fasting for the test but, if they don’t, the doctor can make the notation on the labs himself and sign it.
- The fasting glucose has to be less than 225. I would recommend that before doing the test checking your glucose on your home meter and, if it is less than 210, you should be “safe”. (Home meters don’t have the same accuracy as a venous blood draw so you don’t want to be 225 on your home glucose meter because it may actually be higher.) (Ideally, in terms of general health you obviously you want it lower than that but those are the cut off numbers for the testing). The C-Peptide has to be less than or equal to 110% of normal reference value. If you have poor kidney function (a GFR less than 50) then it has to be less than or equal to 200% of the normal reference range. (Which I believe translates to the level can’t be greater than 110% of the lower limit of the reference range- or 200% in people with diminished kidney function).
If your blood sugars are at the higher end when you do the lab and your C-Peptide is borderline qualifying. Try the test again with lower fasting glucose it will make the C-Peptide lower.
Your doctor will have to send in chart notes stating with all the above information and it should notated that you have seen the diabetic nurse (if you have…If you haven’t- you need to for coverage). Should also notate things like if you have variability in your glucose and/or your A1c is greater than 7.0%.
To maintain coverage with the insulin pump you HAVE to see your provider EVERY 90 days. Do not be late. Medicare is a law so when they say within 90 days from the previous appointment they mean within 90 days, not 91 days.