Trouble obtaining enough pump supplies with medicare

I have been having problems receiving enough infusion pump supplies from CCS Medical. My endo and his staff are pulling their hair out trying to get them to send me 40 sets for every 90 days like had been happening until 2018 when the rules were changed at Medicare. A person at Medicare told me that since the trump administration took over Medicare they have made cuts to things like insulin infusion sets. I normally change every two to two and a half days, but of course there sometimes are clogs (2 this month) and one set that was accidently pulled out last month. Since starting the pump some 30 years ago I have always received 40 sets per 90 day supply, but now it has been changed to 30 set so I am going to be 15 days short at a minimum again this order period. I managed a couple of samples the doc had last order period. My doctor has asked, as I have asked CCS exactly what they need and while they don’t give a concrete answer we think that the proper information has been supplied, but CCS still says nope! If someone has a doc that has successfully presented the exact language or voodoo spell or what ever to get CCS off their butts, please provide me with that info. At this point I may have to give up the pump and go back to 6 or so injections a day with poor results. I have been on the pump for about 30 years now and my A1Cs are 5.9 to 6.2 with the pump. Talk about anxiety causing crap… at this rate I will not make it to Christmas alive.

@Ron23, I hear you. I hate it when third parties threaten my steady source of life-enabling diabetes supplies. I long ago decided not to play fair in this game. I get my doctor to “order” me to change my infusion sets every two days. If I let it go 2 1/2 or 3 days then that accrues to my supply benefit.

I know some members here can get 40 sets for 90 days by getting the doctor order to change every 2.5 days. Since your supplier does not want to play nice, I would see if you can get your doctor to order a set change every second day.

Do you have to go through CCS? What pump do you use? I use a Medtronic pump and get my Medicare Part B infusion sets and cartridges from Med-T. Instead of sending me 45 sets for 90 days, they round up to 50 and that helps, too.

Do you a have back-up plan and supplies for basal insulin if you need it?

I live by the adage, “All’s fair in love, war, and diabetes supply orders!”

Perhaps it is not Medicare. We are similar in that we have been getting 40 sets for 90 days for a number of years now. The prescription is written to change the pump site every 2-1/2 days.

Earlier this year, CCS Medical said they were only going to send 3 boxes instead of 4 boxes. It was a considerable amount of back and forth with them before they agreed to continue with the 4 boxes.

I have no idea what their major malfunction was. If the doctor ordered it and the insurance covers it then what business is it of the distributor to change the quantity?

Are you able to change distributors away from CCS? Realistically it sounds like all distributors have a bad reputation so it could be from the frying pan to the fire on a switch to another distributor.

Have you asked for a prior authorization to do a quantity limit override? And/or ask for a medical doctor peer to peer review to get it approved? Also if all else fails get your state representative involved, they can help with getting the quantity limit override approval.

CCS Medical…UGH! I had the misfortune to use them for a short time (in 2016) when I went unto Medicare. Then they stopped providing supplies (Strips) for Medicare patients. SO I was told to use Edwards. When my strips weren’t forthcoming, I called and they said,“oh, we aren’t contracted with Medicare any longer”. Ah, like ARE YOU KIDDING ME?? I was told to use you guys, I called you, you set up an account, and said I would get strips from you. Good god, these companies are UNBELIEVABLE!! (for the moment)

All these suppliers are either the devil or a blessing - CCS works great for my wife - never a problem - they did stop the strips so she just gets them from the pharmacy under part B

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Well after 2 hours on the phone with a Medicare DME Claims Specialist, they could not understand why CCS has not sent me the correct number of sets and suggested that I call them and ask. CCS said they did not receive proper documentation from my doctor, checked with the doctor and they say they have faxed the information repeatedly! Called Medicare and asked for what other supplier they had that I could use and they gave me three names. I called them and all three said they do not supply infusion pump supplies! I am running out of ideas and persons to contact. I am at my wit’s end and don’t know where to turn to next. It seems like NO ONE at Medicare or at CCS Medical knows what to do, or even cares.

What pump are you on?

Though I am not on Medicare, Edgepark gives me this run around all the time. They even claim that the insurance company won’t cover more, but yet i ask the insurance company and they said they cover it as the prescription is written. I stopped doing the 3 month continue care ordering and it hasn’t been as much of an issue, other than when they screwed something else up and then blamed it on the infusion sets.

I had a similar problem, although not with Medicare or CCS. But the problem was that my doctors office was using the wrong FAX number.


@Ron23 - You may want to try the approach which @Dave44 has mentioned.

Give direct from Medtronic a try?

I started Medicare in the spring of 2017 and immediately began received 4 boxes of pump supplies every 3 months from CCS Medical with no issues. With my first order of 2018, they only sent 3 boxes with no explanation. I called them multiple times and my endo sent multiple letters of medical necessity, etc. They were very unhelpful and I never did receive the 4th box.

Meanwhile someone I know had switched away from CCS Medical to Solara and gave me the name of her rep who worked very hard to get her a new pump as well as sufficient infusion sets. I gave the rep a call and she did a lot of work to help me get a override of the normal 3 boxes of supplies to change sets every 2 days and get 45 sets.

Two pieces of information that I was given:

This from CCS Med: “For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information, as applicable, such as duration of the patient’s condition, clinical course (worsening or improvement), prognosis, nature, and extent of functional limitation, other therapeutic interventions, and results, past experience with related items, etc.”

From my rep at Solara: "If the Md can check 1 or more of following on LMN you will meet criteria.
Please have them check the boxes on the form. Also, it would be good if mentioned in the new chart note visit.


Please note that the info requested from Solara was on top of a form my endo had already filled out. I also had to provide 2 months of BG supplies (not just 1 month).

Back to my story. For one shipment I got 45 sets from Solara because they were able to spilt boxes. Then the shipment only had 4 boxes because now they can’t split boxes. I was given the option of paying a very small amount ($18 I think) to pay for the second half of the 5th box. I chose not to because I didn’t want them to have my credit card number. But right now I am getting 4 boxes and that works for me for the most part.

Also I have had a couple of people give me boxes of sets that they no longer wanted. I save extra tubing and have been able to use sets from Medtronic and Animas with my t:slim pump by substituting tubing. Facebook has a local diabetes group and people are very generous sharing unused supplies.

My understanding is that you can call any supplier for your pump supplies because they are not under competitive bidding. I liked CCS Medical because they were very organized and I could do a lot of things through an online account. Everything with Solara is by phone and I don’t find the reordering to be fabulous. But in general I am getting what I need. If I choose to switch again, I would probably try Byram.

I dealt with CCS Medical for ove five years and found them very difficult to deal with. If my doc forgot to dot the Is, his authorizations would be denied.

Try ordering your supplies directly from Medtronic or consider using 500 insulin (5 X more concentrated than regular insulin) which will allow you to get buy with fewer infusion sets.