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Re: Re: [IP] Medicare ALJ case



If you call Medicare, the person you talk to will tell you that Medicare  
pays for your pump and testing supplies as ordered by your doctor. The  
problem is that they don't. On the payment side, they see 8 to 12 test  
strips being used (they only feel 2-3 tests per day should be needed) and  
deny the claim. We are regulated by those who think in terms of what the  
general population hears - diabetics can manage if they ate less and  
exercised. Everything we hear on TV, etc. says diabetes can be managed if  
you eat less and exercise. Ask most people (our Medicare payment system  
included) and that is all they understand. The difference in care for  
insulin dependent diabetics just isn't well know or understood. I worry a  
lot about what will happen if Medicare makes me go through all the steps,  
as they have Phyllis, to receive payment for my test strips. And I  
understand the general statement that if we take care of ourselves (hard to  
do if we are denied the number of test strips needed) we will live just as  
long as anyone else. But to me that is like saying all diabetes is caused  
by being overweight and not exercising. General statements with this  
disease just don't apply to everyone. Even with great care I know there are  
people who develop complications. My brother and I grew up with the same  
care. Basically we had parents who didn't understand the disease, couldn't  
afford many doctor visits and we just took our insulin and lived like  
everyone else (no home testing in those days, etc.). My brother died at age  
48 from heart, kidney, etc. complications caused by his Type 1. I am now 62  
and still here. Care was the same (not that great years ago) but as  
individuals we developed complications differently. Thanks for letting me  
carry on a bit about this disease. It just is a shame that the one thing  
that is needed to help us manage and live longer (frequent testing) is  
being denied by the insurance industry (Medicare).

Shirley, dx age 5, 1954 Type 1; Animas 1250; Animas Ping

On , Beverly P White <email @ redacted> wrote:
> Sorry I am hoping in the middle here....reconsideration of what? Medicare
paying for supplies?Bev, mom to Mary, almost 18, dx 1997, pumping 01 and  
looking
at Medicare for disability

> --- On Fri, 7/1/11, Phyllis email @ redacted> wrote:

> From: Phyllis email @ redacted>
> Date: Friday, July 1, 2011, 8:34 AM

> Denise,> I have been in contact with one of my Florida Senator's in  
> Washington. He is
> willing to help, but, he is the Senator from the state of Florida. He has  
> filed
> another Reconsideration on my behalf. He submitted all the required
> documentation and is waiting to hear back form River Trust. River Trust  
> is the
> entity that decides our fate and then it would go to the ALJ. My supplier  
> filed
> for the Reconsideration and was denied by River Trust (2nd appeal).

> Phyllis

> ----- Original Message ----- From: "Denise" email @ redacted>
> Subject: Re: [IP] Medicare ALJ case
> > > Listening to everybody talking about Medicare and being not so far  
> from being
> > on Medicare, what all Type 1's might want to get into, if we can get  
> the ADA to
> > carry it, is a class action lawsuit.
.
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