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Re: [IP] Meeting Medicare Requirements

> Michael:
This is good info James,
I will start a followup with all three pump companies to try and 
improve things for Medicare patients.


> 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.
> James
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