I heard back from both Tandem (Tslim Pump) and Animas (Ping Pump), and they are requiring a c-peptide and fasting blood glucose. I do have a meeting with the Animas rep on Friday, for the demo.
I am feeling a bit discouraged, I am a type 2 (as far as I know) and heard that many times (especially with Medicare replacement policies) T2's are not covered for the pump.
I am angry that insurance companies can have so much control over something that a doctor deems a good idea.
The one thing, thus far, going for me is that I am on the vGo. The vGo is like a disposable insulin pump that you change every 24 hours, but you only get 60 units pre-filled in it (and take 'clicks' depending on what you eat.)
It is limiting, which is why my doctor felt an actual pump was a good idea.
Fingers crossed!
Unfortunately Medicare has a distinct bias against T2s initiating pump therapy. The criteria from Medicare are:
Criterion A: The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin doses for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen:
- Glycosylated hemoglobin level (HbAlc) > 7.0%;
- History of recurring hypoglycemia;
- Wide fluctuations in blood glucose before mealtime;
- Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl; or,
- History of severe glycemic excursions.
So basically you have to demonstrate that you have achieved poor control. For most people getting a pump before entering Medicare is the only sane option.
I'm not saying Medicare won't cover a pump, just that it will likely require a letter of medical necessity and a hassle.
Thank you so much for all your help, again :)
My A1C is at a 6.9 right now. I have hypoglycemia every so often. Definitely have Dawn Phenomenon and wide fluctuations in blood glucose before mealtime. Does Medicare require a log? Otherwise how would they know/tell?
PS What's a glycemic excursion?
So many questions. I believe your doctor will document things, he may ask for a log. A glycemic excursion is a wide swing in blood sugars. Often this is caused by overcorrecting.
When I got out of Rehab broken hip. I needed a wheelchair and a walker. Medicare said you can have one but not both. Idiots I needed the WC to get around and the walker to help me learn how to walk again. I took the WC for 135 days. Went to a very nice thrift shop and got a new walker for $12. H ope all is well with you. At age 87 I would never trt to walk without a walker. Reed
Hey all. I go to my diabetes doc on Friday a.m. for a c-peptide test and fasting BG. Met with the Animas rep, and love the Ping. Moving along... just wanted to update :)
