Hello
I see my Edno once a year and in between by telehealth every 3 months for the Medicare requirement. My office just got a request from my pump supplier saying the telehealth visit did not qualify. Anyone else having any issues.
Thank you
mine has always qualified.
I’m on an Omnipod, so I just have a visit every 6 months for the CGM. But my endo only does telehealth visits, she used to fly over here and doesn’t anymore. We don’t have an endo on our island so it would be a huge issue. You might try calling a different supplier or Medicare and seeing who is the one requiring it. I’m not sure I’m right, but I believe Medicare used to require in person visits and relaxed the rules and allowed telehealth visits when Covid hit?
To me it sounds like it’s been extended to Dec 2024. But I could be wrong. Who is your supplier? I’m sure people would like to know in case they have an issue too. It might be as simple as getting a different supplier. But I really don’t know and I haven’t heard anything about Telehealth visits not qualifying at least not yet anyways.
But I also came across this. CMS is the Center for Medicare and Medicaid Services.
It’s under Discontinuing The Use of Virtual Direct Supervision for maybe Part B coverage of certain things? It sounds like it might be requiring in person visits. So totally confused here, but this is per a 3rd party Foley and Lardner LLP.
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No issues. They are pushing the telehealth pretty hard in my area.
Are you saying that the insurer doesn’t like the telehealth? I don’t know why the supplier would have any interest or say in how your office visit is conducted. That doesn’t seem correct. Maybe a misunderstanding somewhere?
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I am pretty sure that is not up to the supplier to decide.
That decision should be based on the doctor and the insurance company. If the insurance company approves the supplies, the supplier just gets the money from the insurance company and sends the supplies.
I suggest you call the insurance company and ask them. If they say it is okay, you can then conference them in with the supplier.
A lot of times the suppliers create “extra” requirements just to ensure that they get a payment.
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I hope that this isn’t the case because I was going to approach my Endo about using televisits to satisfy the new anal 2023 requirement of four pump prescriber visits a year by Medicare Part B continued qualification. Three of them in my case are a waste of time. The endo doesn’t do meaningful physical exams, just looks at test results. I test BP and SPO2 daily, weight weekly.
The many other doctors that I see several times a year have ample opportunity to see if there’s something off that I don’t. I’m not reluctiant use doctors, just don’t like wasting their time or mine. I contact them whenever I see a change in my health or an abnormal test result.
Who’s your supplier? I have Edgepark and they ok’d my order just from an audio-only call back in October. Was actually just on the phone with the Diabetes Educator about something else Medicare related and mentioned needing to visit. He asked a few general questions about my D situation and said he’d try entering the call as a visit note in my record. Edgepark seemed to be satisfied with that.
Seems like there is no end of self-contradictory Medicare info out there concerning D and DME stuff. The phone agents themselves can be totally clueless (I struggled for months to get straight answers about how to do the insulin-as-pump-component thing). Someone recently posted on my thread that their DME supplier told them Medicare now requires a fresh c-peptide test every year. Is this even true? Who knows? When you layer on the different DME suppliers and their insurance departments and what THEY think Medicare requires, the error bars get pretty broad.
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I just saw my endo last week.
My next two appointments are set at 3 month intervals. The first is a televisit, suggested by them. The second is my annual in person.
Curently the Medicare site says:
Telehealth includes certain medical or health services that you get from your doctor or other health care provider who’s located elsewhere using audio and video communications technology (or audio-only telehealth services in some cases), like your phone or a computer. Telehealth can provide many services that usually occur in-person, including:
- Office visits
- Psychotherapy
- Consultations
During the COVID-19 Public Health Emergency and through December 31, 2024, you can get telehealth services at any location in the U.S., including your home. After this period, you must be in a office or medical facility located in a rural area for most telehealth services.
If not for Medicare insulin pump requirements, I’d only need endo visits every 6 months. If not for my PCP who won’t have anything to do with insulin management, I wouldn’t see an endo or a doctor except when I had a problem and they had a solution, not just diagnoses and prognoses. All they are for me is prescription and insurance gatekeepers.
They just take my vitals, remark that my A1C is lower than they feel comfortable with, but since I have no evidence of hypo, I should keep doing whatever it is I’m doing, because it’s working.
When I start MC, I will have an in warranty Tandem X2, but only a few months left. Wondering what rules are for Medicare to cover supplies if MC did not cover initial pump purchase. And if they would cover new pump at end of my current 4 yr warranty period.
Type 1 for 58+ years, and c-peptide tested a few times to prove it! But likely to have to prove it again.
Medicare B will only cover supplies for durable equipment purchased by them. A Medicare D supplement will cover prescribed insulin regardless of you its administered.,
If Medicare didn’t buy your X2, as far as they are concerned you don’t have one. Your supplemental insurer might care.
You will need to qualify for a new Medicare durable equipment insulin pump the same as if you never had one. They will provide supplies under Part B for 5 years from delivery of that new pump, paying 80% of the cost after an annual deductible.
The process takes time.In my case it took longer to get the insulin from the pharmacy than it did to get the pump. I had a pump a week after my doctor submitted the forms to the supplier, couldn’t use it for 2 weeks because they needed to certify that I’d received training. Then it took the pharmacy 3 weeks to get the forms filed out right, approved by Medicare and obtain the insulin from the special distributor.
(I ran out of my starter vial of Novolog before I got my Medicare Part B Novolog - and had to pay the Part B 20% copay until they were sure that they would be repaid by my Part B supplement insurer. Hopefully your pharmacy experiece will be better than mine was.)
Medicare B will only cover supplies for durable equipment purchased by them. A Medicare D supplement will cover prescribed insulin regardless of you its administered.,
If Medicare didn’t buy your X2, as far as they are concerned you don’t have one. Your supplemental insurer may care. You will need to qualify for a new Medicare durable equipment insulin pump the same as if you never had one. They will provide supplies under Part B for 5 years from delivery of that new pump, paying 80% of the cost after an annual deductible.
The process takes time.In my case it took longer to get the pharmacy prepared with the right paperwork for Medicare approval and them to order the insulin from a special distributor than it did to get the pump.
If you want Part B coverage and already have a Part B supplement, not a Medicare “Advantage” plan, your maximum possible cost for pump and insulin would be your Part B deductible - $226 in 2023.
If you want Part B coverage and already have a Part B supplement, not a Medicare “Advantage” plan, your maximum possible cost for pump and insulin would be your Part B deductible - $226 in 2023.