Yet another rant about Medicare

So, although I’m T2, I’ve been on insulin for nearly 35 years and on a pump for 16 years. Life was good…until Medicare. I’ve had problems with getting enough test strips in the past (not from my doc, but from Medicare), had paperwork lost and not gotten supplies on time. Just found out that, once again, Medicare is imposing a stupid arbitrary rule for getting pump supplies.

I had TKR on my right knee in May. Luckily, I was off home-care PT and nurse in time to get my next supply order. Just found out from Edgepark that when I get my next TKR on the left knee at the end of August, Medicare will not allow them to ship my next supply order because it won’t have been 60 days since I will have been off home-care PT. I’ve been told that the visiting nurse has to order my supplies…what??? I will have too many sets to reorder while the nurse is still coming, but they won’t let me re-order until I only have 5 or so sets left. I was told to get my doctor involved - seriously? Yet another batch of paperwork he will have to do for ABSOLUTELY NO REASON! Home care does not manage my diabetes care. In fact, even in the hospital my doctor put in my chart that I am to monitor my own bg’s and insulin intake, not the nurses.

Okay,I’ll deal with this, but I just had to get this off my chest in a place where people will actually understand, because my family doesn’t have a clue as to why this pisses me off.

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mainly edgepark will say that…when i deal with CCS they told me that i have to visit my dr every 3 months. with the local company i use i dont need to see my dr every 3 months. i just get a month supplies vs 3. medicare will cover if you have the medical of necessity letter. im telling you that letter helps with everything. ive had to use it several times with medicare. i refuse to use edgepark anyways as they screwed me over. medicare does cover pump supplies. ive had no issues with getting them covered. hope everything will work out and your able to get your supplies.

I’m not on Medicare, but I know at one time they required certain test levels (c-peptide), to be below a certain level to get covered for pump purchase. If you have existing pump when starting MC, not sure if it applies, or you might get hit with that when you try to get a new pump.

If they don’t have records approving you for pump, might impact your ability to get coverage for the supplies. Just a heads up, and maybe someone with similar experience will chime in.

Amy and MM: Thanks for your replies. I’m not having trouble getting approved for pump supplies normally; it’s only going to be a problem because I’m having a major surgery and will be receiving home care for 4 weeks. The last time I had the surgery, the timing wasn’t that bad, and the shipment of supplies was only delayed a week. This time, the timing is not so great, and my shipment from Edgepark will be delayed by nearly a month! According to Edgepark, this is a Medicare rule that if you’re receiving any professional home care (nurse, physical therapist, etc.) THEY have to order your supplies, and Edgepark cannot ship until you’ve been off professional home care for 60 days.

Normally, this isn’t a problem…just came up because of total knee replacement surgeries. When they send you home from the hospital, an R.N. comes in every 2-3 days for 10 days until the R.N. takes the stitches out, and physical therapist comes in for 4 weeks. Last time (first knee replacement) the timing was such that I had received a supply shipment just before the surgery, so 60 days was not a problem. This time, my next supply order would be due to ship less than a month after the surgery, which means it won’t have been 60 days since I am released from home care. BUT, since I get 3 months supply at a time, Medicare won’t ship anything while I have home care, and Edgepark won’t ship anything until it’s been 60 days, which means I’d be out of supplies for two months! ARGHHHH!

Ruth, is there any way you can postpone the surgery until the right “window” to order supplies appears? I know when my husband had both hip surgeries, we had choices and we did postpone his one hip surgery by a month or two, albeit for a different reason.

That’s amazing, I was not aware of that. Have you spoken with someone from Medicare to confirm?
Seems it should relate only to supplies that are associated with the reason for home care.

Tapestry: Nope, that’s the best time for me to do it. I live alone, and my best friend is coming in from another state to stay with me through surgery and several days after I come home. That’s the only time she could be available for 10 days.

MM1 - A good point. I definitely will have to look into that. I’m really not pleased with Edgepark, and it wouldn’t surprise me if they just made this up.

Thank goodness for friends! I’ll keep good thoughts and prayers going for you!