Pump supplies & insurance


#1

Ok, its been a while since I posted but I HAVE to vent. I’ve been a type I since 1997. I have two children (grown now) that are also type I (12 & 13 when diagnosed). ALL of us are on Medtronic pumps (670g). I’m retired from the US Navy and now have Medicare with my Navy insurance covering the balance. I NEVER had a problem getting my pump/CGM supplies until now. Medicare/Tricare demanded a CPep-Tide (sp) test before my re fill. I started this process 3 weeks ago and finally got them to mail my supplies TODAY. first test was invalid because they failed to do a BG with my blood (your BG must be 250 or lower at the time of the test. 2nd test was good. Insurance wasn’t happy with the physician notes so, a 4th office visit was required. Luckily I have kids who can help me when I’m low and vice versa otherwise I’d be down for the count. Medicare probably paid $1,000 or more in office visits and lab fees to keep from paying for my supplies. They act like I was “cured” and scamming them for supples. Yes, I’m fortunate to receive medical benefits and I feel for those who don’t. My anxiety has been off the wall the last 3 weeks AND mad As Hades.
Sorry fo the wordy post but I had to vent.


#2

Bummer. I have had to do one C-Peptide when I went on Medicare. My endo complained that they require it every year but I think he was wrong. ( I started Medicare more than 3 years ago) My wife failed her first test and had to go to the lab a few more times before they would pass it–she was just on the edge of their allowed limit.


#3

Wow, every year! That would be a royal pain


#4

Yes, but I’ve not had to do it. I don’t know if Medicare changed the rules after my endo told me that, or what. The fewer labs, the better (to a point).


#5

I went right into medicare without any CPeptide test. I have been on for medicare and using the pump for 10 years. Is this a new requirement? Maybe I was grandfathered?


#6

You might have been. They also required that I tested my BG at least 4 times a day. I also had to provide 30 days of manual BG tests. Bottom line is they wanted every hoop they could.


#7

That does sound frustrating, @Bob_McAdams. We all need to vent from time to time. That’s one of the purposes of this community.

I understand the c-peptide test as a one time requirement for Medicare coverage for insulin pumps and pump supplies. I do remember that the c-peptide had to be run concurrently with a plasma glucose measurement under some threshold value, 250 mg/dL (13.9) seems about right.

I think you just got caught in a bureaucratic trap. I know I would have been angry with that experience, too.

I react similarly to these kinds of situations and I know it’s not good for me. Acute anger is by its nature a relatively short episode. I think our bodies can handle that relatively well. Extended periods of anger like what you felt are not good for us. I can’t tell you how to cope but neutralizing anger that lingers is a challenge we best take on. Your writing about it helps. I find talking with others is another way to let off steam. Regular exercise helps me as well.

I hear you and get where you’re coming from. Try to be kind to yourself and keep your focus on longer term goals. I hope you’re doing better now.


#8

Medicare rules can just suck!

I just became Medicare eligible and I’m going through a similar set of hoop-jumping exercises. ARRGGHH!!

I went to re-order my pump supplies and WHOOPS! I ultimately had to convince my supplier to allow me to purchase one box of infusion sets without insurance so I wouldn’t run out.

Now I have to run around and get all of the “i’s” crossed and “t’s” dotted to prove that after 45+ years I am actually a T1D - because all my previous doctors were incompetent, right?

I’m stressing over how to account for the “purchase” of my OpenAPS-compatible pump that was donated to me.

FWIW, I will be contacting my Congressperson and having a discussion about why PWDs have to PROVE they have a chronic condition, just because they turned 65.


#9

I’ve read online about how some people get the person who donated the pump to you to write and sign a “gift letter” acknowledging that they freely gave the pump to you.

I assume you’re concerned with securing a stream of pump supplies going forward. I suspect you’re talking about a Medtronic pump. Perhaps you could talk with their customer service and/or “registration” department to see what that letter needs to include. I wouldn’t be shy about posing this question to Med-T as a “friend” of someone in this situation so that you can keep your options open.

I did experience a challenge with the Med-T registration department. I had, however, been a long term user of several earlier generation of Med-T pumps and I was in their database.

At one point I addressed the bureaucratic reluctance with, “Do you mean to say that you’re willing to get in the way of the best glucose control I’ve experienced in 33 years of treating my diabetes?” That prompted quiet on the other end of the line. I received the supplies I needed and have experienced no further difficulties.

Good luck with your OpenAPS experiment. Automated insulin dosing (AID) is the best care I’ve ever been able to give myself. Combined with a carb-limited way of eating, I’ve enjoyed my lowest A1c, most time in range, fewest hypos, least glucose variability, and lowest overall glucose average. On top of all those positive attributes, AID only takes about half the attention and effort as my former regimens – it’s a huge boost in quality of life.


#10

Thanks - great suggestions. Yes, I’m on a Medtronic, but I have never been a previous user. To date, I’ve been able to avoid any direct talks with Medtronic by using Edgepark for the supplies. On my employer-sponsored insurance, once Edgepark received the prescription, they just filled it. But now, Edgepark is asking all those Medicare-related questions. I think I might be able to get a “bill of sale” from my Endo, who kindly donated TWO broken pumps to me that I was able to fix using the OpenAPS links.


#11

This whole business makes me vaguely ill. I was dx’d T1 in 1983, there wasn’t any ambiguity about it, I’ve been on insulin for 35 years, a pump for the last seven, but until recently never had any of these tests. It wasn’t a thing in 1983! I changed endos about 4 yrs ago though, and just for the heck of it we ran the peptide and one of the basic antibody tests. I gather the c-pep has to be done under specific BG limits, so I don’t know what it would show if I did it under more rigorous conditions. but my result was near normal range (I seem to produce some endogenous insulin, mostly late afternoon, which is when I had the blood draw), and I was negative for the antibody test, which my endo tells me is not unusual this long after the original infection. But I’m only a few years from Medicare and the idea that I’m going to have to suddenly be tested and, I dunno what, rediagnosed as T2??? Denied pump supplies, CGM supplies I’ve relied on for years??? WTF??? My endo says, don’t worry, there’s no doubt about your diagnosis—I mean, I should hope not after all these decades—but is that going to matter to the bureaucracy? Maybe I can prove it by dying, would that help?


#12

I’m guessing it was likely a change in policy (unless you didn’t even realize you got a c-peptide test along with your routine testing). It wouldn’t be “grandfathering” because I’ve been pumping for many years before I went onto Medicare and had to get a C-peptide, as did my wife, a fellow pumper from the 1990’s.


#13

I recently had to reorder sensors for my CGM, and my insurance said they couldn’t do it for another month. My reason for the earlier than expected need for refill was because of many of the sensors not lasting as long as they should. I eventually had to call to explain this to Medtronic so that they could send me a few extra sensors to last me until my insurance was willing to do it. But they also said it wasn’t normal for them to not last that long, and eventually had to meet with a rep to figure out why. After we eventually figured out the problem, hopefully I won’t need to fight with insurance again, but even if I wasn’t inserting the sensors the way they wanted before (I am not), the way I was inserting them before was giving me good numbers, and it was fine with my trainer when I got the pump, so I don’t think I should be punished for doing something I was originally told was OK.