Good idea to bring up the DCCT. This was like the pivotal study that found (not surprisingly) that diabetics who test more frequently have better A1Cs and better long-term outcomes. Duh! Also a good point re: DKA. The only time I experienced DKA was on a pump.
I'm with you acidrock. There is no excuse, NONE, for that kind of ignorance in a healthcare professional. Especially one with 35 years of experience. Type 1 diabetes USED to be a rare disease, but it really can't be considered rare anymore. If you're not willing to do your homework, Nurse Ratched, it's time to retire.
Not to mention being so horribly unprofessional as to base her prescriptions on what Medicare allows, rather than on what the patient needs. What a twit.
Some insurance will cover pumps and sufficient strips for T2s.
It has been just over 3 weeks since I requested a refill on my test strips from Medtronic. I keep getting the run around from both Medtronic and my Dr office. Medtronic says "we're waiting from the Dr. office". Dr. office says "we waiting for the fax from Medtronic". Medtronic is nice enough to inquire "how many test strips do you have left"? Do I have to run completely out before they will send them? You young folks take good care of yourself and try, if possible, to put a little money aside for buying test strips when you are old. There is no respect for older people anymore.
Sadly it seems you have been caught in having to substantiate your medical needs. Since medicare/medicaid requires something which documents the medical necessity of testing more than 3 times a day, your doctor has to write the letter and fax it over. This is routine for an endo, but not something a GP may do all the time. If you can get a copy of the letter or fax, it may be good to have on hand should your files get "rearranged" in the future.
I also make it a practice to maintain a hoard. And what I report to the insurance company and suppliers are what "I have been prescribed and what I need according to that prescription." The fact that I buy or maintain a hoard to protect myself is none of their fr*gg*n bussiness. The number I have left is zero when I get to the end of my three months and my prescription provided supply is gone.
And you are right, sometimes this just feels like a faceless corporate money grubbing machine, whether you are young or old.
This is an issue that many on insulin both Type 1 and Type 2 are running into with Medicare.
My brother is Type 2 on insulin covered under Medicare and a Medicare Advantage Plan. His diabetes care is managed by his PCP, an internist, because the Medicare Advantage Plan only has one endo in our area with a wait time of 6 months to get appointments because there are not enough endos that are willing to take Medicare patients. My parents had a difficult time finding GP doctors in our area that would accept new Medicare patients.
My brother's Medicare Advantage plan will only cover 3 test strips per day. I suggested to him that he get his PCP to justify additional test strips because he had a severe low episode that could have been prevented if he were testing more frequently. His PCP is just as reluctant to battle with Medicare as yours is Mayumi.
Medicare is what scares me about retirement. I've already decided that I will probably work until I die as long as I can maintain employer based insurance coverage. My podiatrist told me just last week "save your pennies because Medicare isn't going to pay for squat by the time Congress gets through". Very sad state of affairs.
Your problem just keeps running through my mind. I have a tendency to "attempt" to use humor to deal with problems, and while I do really care, sometimes I think that maybe a little giggle helps us tremendously. That being said here is a thought - how about you putting together a little package for the nurse at the doctors office. This package needs to include a (your) pump, a 2 week supply of pump supplies (reservoir, infusion sets, insertors, extra batteries, any tape, skin tac, alcohol wipes, etc), your glucometer, strips, lancets, 'poker', your charts (or software to set up computer downloads) for your test results, whatever book(s) you use to count carbs, the scale (if you use one) to weigh everything out, and a big bottle of saline. And then ask the nurse to be so kind as to test, weigh, measure, chart, calculate carbs, bolus, test, weigh, measure, bolus, ......... for two weeks while your nurse continues to do her job both at the doctor's office and at home.
Maybe we just all need to show up with the above box at Medicare and let them have a go at it? I just don't know what the solution is, I have just over 10 years yet before I have to begin the process with Medicare and I am not looking forward to it at all.
Technology/Science/Doctors have provided so many tools to help all diabetics prevent or reduce complications - I am not saying it's easy, but the tools are there. You would think we would be smart enough to provide access to these tools, saving money in the long run.
Just keep fighting Mayumi. I guess it's all we can continue to do. Good luck! My thoughts are with you!
I'm not big on privacy, but with my previous endo, every time I walked into an exam room there was a paper, easily visible to all, listing all of the patients for the day and their respective A1C's. I always found that a bit odd. Since they also write the number in our "chart" (folder), I never really understood the point of that paper.
You're afraid. I'm angry. Just reading this makes my blood boil.
Here's what I suggest you do... it worked for me: call Medtronic and ask to be put in touch with your local rep. Ask your rep for the names of endocrinologists that he/she works with regularly, who really understand the pump and how to use it, and how to prescribe the right amount of "stuff" (test strips as well as infusion sets). Then call that doctor and make an appointment.
That's what I did when I moved to a new state... I found my endo via recommendation from Medtronic. And this guy knows the pump inside and out. His knowledge of pumping insulin, as well as how to retrieve and analyze all kinds of data I didn't know even existed on my hip, puts my old doc to shame. These two should work together, not be at odds with each other, and the Medtronic reps can tell you who are the easiest ones to work with.
Amen to that!
You an me both. I'm terrified of going on Medicare (if it still exists) I've tested 7 to 10 times a day for 20 or more years. As a result, I have NO side effects. It's about PREVENTION people!! I'm wondering if the rules are different between T1's and T2's? I say we all form some sort of rallying group, sign petitions, something that we can send to our congress to get this stuff covered!
Isht! Can you overrule her and bring your doctor into this discussion?
Also, while there is going to be great advice here, I'd head over to the insulin pumpers dot org site. There is a wealth of info there and helpful people too. I'm just thinking since it's a dedicated community for pumpers there is probably someone who might have gone through this before. (Also, they've gotten me out of a couple of pumping emergencies.) Head over there and see if anyone has advice for you.
Okay, I read down a bit in the thread. I'm not sure if this is an option for you but can you find yourself a university affiliated endo? I insist on this as I get the best level of care and those endos are usually on top of the best practices and research. I'm not sure where you're located, but check your local university hospitals and see what your options are. If you're type 1 and on a pump you need to test frequently, period. Also, your A1c is good because you've got the assistance of a pump. This nurse is out of her mind.
Excellent suggestion. Apparently when I called Medtronic yesterday they were having phone problems as I waited about 35 minutes on hold - which is quite unusual I think, then my phone connection got cut off.
This morning while talking with my Podiatrist at my post surgery check up, I asked him if he knew of any Endos in our town taking new patients. Turns out there are only two in the whole town. I did call one and she is taking new patients who have Medicare insurance. So......now I have an appointment for early April. I just hope she is knowledgeable and kind.
Also have an appointment with an Internist in two weeks (he was also recommended by my Podiatrist). It seems the Internist has a special interest in diabetes and hypertension. Again.......I hope he is kind. I realized that where some people have a fear of going to the dentist, I have a fear of seeing the doctor. I don't know how to fix the fear.
I hope these doctors will be willing to help you get what you need to keep your diabetes in control. You are your best advocate. Be prepared when you see each doctor, let the doctor know what has worked for you (pump/testing more than what Medicare considers is normal), what is not working for you, and how you believe the doctor can help you. Write it all down. You are in charge - you are "interviewing" the doctor to provide care for you - it's your decision if that doctor is "hired" or "fired!" I wish you success!
Sounds to me like that nurse needs to retire, if she can't find chart notes. I mean really.
Mayumi, I don't know where you are with this? But, just a FYI, I'm switching meters, going with One-touch because it talks to my pump, which I'm starting on. Medtronic has done everything for me, on my behalf. Because I'm getting 400 test strips a month, they too had to send something to my insurance carrier for pre-auth. But, they've done everything. They called me today and said they'll send 2 boxes for the remaining days this month and 8 boxes on Feb. 1st. So, i'm not sure of your hold-up. I don't know if or what my Endo supplied to them prior, I know they had my trial CGM and current 30 day blood sugar logs..but, there's been no problem what so ever.
I do the same thing, bsc. Eric uses on average 8 strips a day, and because of his CGM, we've been able to keep it there and not go over very often (sick days aside). So I'm about 100 strips ahead of the game at this point, but when Anthem suggested he should be cut back from the 300/month the doctor prescribed to 200, I had a raging hissy fit — got the endo to put in a specific request to Anthem stating that 300/month was medically necessary, and it was a good thing I did, because when I lost my job a few months later, it took the better part of 5 weeks to sort out the transition to COBRA, and I had to dig far into my stash to get through it. Ditto insulin -- I always, ALWAYS have at least one extra vial in the fridge. If I hadn't done that, we'd have run out. As it was, I had to beg Medtronic to send me some "sample" insertion sets.
It is sad that you feel like a criminal when you are at your pharmacist. I know that feeling too.
Just an update to my post: My test strip order has been shipped - all 6 boxes of them which means I can test 3 times a day. Anything over that I must buy my own test strips out of pocket - guess the GP had the final say on the amount. :(
Gee, I'm afraid, too. I haven't had diabetes very long, it is rather "mild" in some people's opinions. The day could be coming that the insurance will decide I don't need the strips. I can stay off meds for a little while, sort of a drug vacation, and the only way I know that my vacation is over is the return of sudden spikes. As long as I have my current doctor, may not be a problem, but what is gonna happen when retirement comes along, a change in insurance, etc. Stories I read here on TuDiabetes keep me afraid.
We're here to keep you informed and aware, Picklebird (love that name, by the way!), not afraid. I sure hope we're not keeping you up at night.