so sorry you hare having problems @mohe0001 . Insurance can be a nightmare sometimes. Hang in there!
You think I would like the anti-low blood sugar algorithm in the onmipod 5, Brad? The Doc really wants me on it.
You know that they are one of the federal governments largest antitrust cases? Right along side the PBMs.
Run far away from om5! Its fda approved so extremely un agresdive at highs to prevent lows. You will not only have zero control of whatâs happening but it wonât even tell you what it is doing dosage wise . It supposed to lean you and auto adjust everything but that can take 1 to 2 months! I hated it. But it is truly hands off so if thatâs what you want then give it a try. Maybe it will work for you .
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I was denied a omnipod during my endo appt. today. frankly I was denied even the ADA minimum standard of care. PTSD from working in healthcare or doc just picked the wrong line of work, hard to tell.
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We should talk this through. You are currently on manual injection and were denied a pump? Just an omnipod 5? Or, any pump? You got the wrong Doc?
Just speaking generally about how things have changed over timeâŚdifferent docs feel comfortable with different treatment methodologies. So, you tend to see Docs with ALL their patients on the same technology. Some of them specialize in Omnipod 5 and feel really uncomfortable with anyone on MI, or visa versa. I think that results in docs putting undo pressure on individual patients to select a treatment method that is best for the Doc. I donât know how to work with that, but this is what it feel like I am seeing out there in the wild.
Thatâs what I figured you would say. Thatâs exactly what I imagine. Iâd rather not put them in a position where they have anymore leverage over my treatment decisions or any excuse to without care. For example, âPt was noncompliant because she refused to activate automated basal AI and run an A1c of 8. Therefore, we will cease to renew all insulin & pod prescriptions.â They do stuff like that all the time. They are bastards. They will sweep away my ability to provide informed consent for treatment like so much dust under the rug. Its unethical behavior on their part, and not in my best interest as a patient.
Thanks, I already vented on another forum. Some poor guy on medicare asked why his DME co. wouldnât sell him a new reader and I worked out my feelings by writing a 3 page post about why he was in one of the many medicare holes and was better off paying cash at this time.
You are right, the doc isnât comfortable with MDI, hence when she said âno one should be changing their basal day to dayâ. I thought she was going to be stuck by lightning inside the building for that one. You were also right when you said docs hate the âsometimesâ on a pump. Thats what really killed it.
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Those cats on medicare are really getting pushed around.
I finally looked this up and I donât believe there is a Medicare rule requiring a Doc visit every three months. If they make anybody do that, then I believe they have classified you as a âlow performingâ patient, which prob isnât fair.
There are somethings written into standards of care, which is more of an issue for medical practice, not insurance, that you see a Doc every 6 months.
But it used to be the norm to have one year scripts. Somewhere along the line, that shifted.
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Thereâs some sort of thing because my CDE CNP has to struggle to make sure I get in in time. Perhaps itâ for my Sensors? Part B? I donât have a chance to check it but I know sheâs really busy and worries about getting me in! Maybe someone here knows for sure?
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Sometimes it takes 3 months just to schedule w/ an endo. This all becomes prohibitively difficult.
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LCD - External Infusion Pumps (L33794)
Continued coverage of an external insulin pump and supplies requires that the beneficiary be seen and evaluated by the treating practitioner at least every 3 months.
Medicare Part B CGM coverage requires being seen at least every 6 months.
Pro tip for making sure you have continuity of diabetes healthcare: Make an appointment before you leave the doctors office. If you live an unscheduled life like me, doesnât matter when the appt. is, it gets you a place in line and you can change it when the date gets closer. On prescriptions, because you are interested in how things work and making changes, be familiar with your state board of pharmacy. https://mn.gov/boards/pharmacy/statutes/ For instance that pharmacist that would only sell you a 10 pack of syringes, thats a pharmacistâs personal problem, not a rule in your state. Pharmacists are people, they have beliefs and a duty of care. Did you ask nicely, maybe offer to show evidence you have an insulin script or at the other extreme, are you presenting as a person that could harm themselves? Same with people who write prescriptions, they choose how many days and how many refills up to a state mandated max. Back to having conversations about making change, be open minded to different ways of doing things and actively seek different solutions. For example, hereâs Californiaâs Pharmacy rules all collected in one PDF.
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There is no rule that a Doc visit is required every 3 months, however, pumpers need to see their Doc/Endo within every 3 month period with charts available within that period or Medicare will not pay for part B supplies such as CGM. For MDI patients the rules are the same except the period is 6 months. Either way, the length of the prescription has to cover these same periods or beyond.
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Ok. Helpful info. Lots of it. I gotta look this over later today.
Check this out. I told you something fishy was going on down there at Walgreens.
Both. They saw the script. They know Iâm diabetic. I was nice. But I might have been wearing a sweater with a werewolf on it, even though it is not Halloween. The temp dropped suddenly. My dog had diarrhea for a week straight because he is 21 years old. All my clothes were covered in dog diarrhea except that sweater. I deemed it Walmart appropriate wear.
Iâll try again. You are right. Iâll wear something that looks less drug seeking. Maybe that was it.
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I had several hassles from pharmacists over syringes and insulin when I was in my 20âs and had long shaggy hair and ripped jeans. It didnât help that this was the 1990âs when every day the AIDS epedimic was in the news instilling massive public fear of syringes/injectables.
Now that I have totally grey hair and a buzzcut I get no hassles at all.
Also today I see ads EVERYWHERE, including giant billboards, of good-looking people giving themselves their Ozempic shots etc. Very refreshing compared to the attitude to syringes 30-40 years ago.
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LOL, Tim. My life was greatly improved once someone ten years older than me explained that if I stopped wearing converse sneakers, then I might be able to get some respect when I walk into a place. 
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