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[IP] Meeting Medicare Requirements


A few weeks ago I requested some information on c-peptide test and indicated
my frustrations with Medicare on not accepting my readings - my last c-peptide
was .8 and Medicare requires: .5.  All of this came-about when I went over the
magic date of 65 years old and Medicare became my primary insurance provider -
Unfortunately all of the Medicare information was being given to me by the
pump manufacturer, they insisted that Medicare would not accept my claim
because I would not meet the c-peptide minimum number.  All of this confusion
has been going on for 2 months, supposedly between myself, Medicare & the pump
manufacturer.  Yesterday, I was finally able to get the correct Medicare 800
number that provides information on diabetes by knowledgeable persons - for
any-one that needs the number: 800 583-2236 - the lady that I talked to, went
into their computer system and produce my records.  First, the pump
manufacturer had never turned a claim, so Medicare had no records on my
request to get supplies.  Second, she advised that c-peptide test is only one
of 6 requirements and that by all means since I have been on insulin for over
40 plus years it would fall under mediating circumstances - she sees no reason
why my claim would not be approved.  She provided me with the name of the
manual that all providers should use, including the page number and the phone
number that they should call - I contacted my pump supplier, they did admit
that my claim had not been submitted because they were requesting more
information from my doctor, the form had not been properly filled? - as I
stated previously, I have been working with the pump manufacturer 2 months.
I was also told that .8 did not meet Medicare minimums and that I would have
to wait till Medicare increases the number - once again, total confusion by
the pump manufacturer personnel not understanding or properly reading
Medicare's manual.  I am very lucky that my secondary insurance provider will
cover all my needed pump supplies, but certainly, when the time comes to
exchange my pump due to warranty, I will look into other manufacturers and ask
a lot of questions, prior to purchasing a replacement. I fully understand that
Medicare coverage of insulin pumps and related supplies is new ( I believe the
law was changed during April 2000), but pump manufacturers & suppliers need to
insist that their personnel handling claims should also become totally
familiar with Medicare requirements.   I hope that this information will help
other diabetics using insulin pumps and getting ready to go across that magic
age of 65; keep in mind that you are going to have to do your own research, if
word comes back that Medicare will not accept your claim.

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