Re: [IP] Medicare & Pumping
Talk to your pump ompany. They know what needs to be done. You can
also talk to the company providinging your pump supplies if you're
using a medical supplier. They also know what needs to be done.
If you have good secondary insurance, they will most likely pick up
the 20% not covered by Medicare. That's what I have, so I can't speak
to Medigap policies.
Although the Medicare policy quoted by John W says "A or B," the fact
is that you have to have a qualifying C-peptide test. So you'll need
letters and prescriptions (both precisely worded -- which is where
your pump company or medical supplier will prove their worth in gold!)
from your doc, as well as the lab work.
I did it with relatively little aggravation by starting with my pump
company who sent me on to the medical supplier.
Get started today!!
On 7/14/11, John S Wilkinson <email @ redacted> wrote:
> Here it is straight fron Insulin Pumpers web page.
> 5. Continuous subcutaneous insulin infusion pumps (CSII) (Effective for
> Services Performed On or After 4/1/2000).--
> An external infusion pump and related drugs/supplies are covered as
> medically necessary in the home setting in the following situation:
> Treatment of diabetes
> In order to be covered, patients must meet criterion A or B:
> (A) The patient has completed a comprehensive diabetes education program,
> and has been on a program of multiple daily injections of insulin (i.e. at
> least 3 injections per day), with frequent selfadjustments of insulin dose
> for at least 6 months prior to initiation of the insulin pump, and has
> documented frequency of glucose self-testing an average of at least 4 times
> per day during the 2 months prior to initiation of the insulin pump, and
> meets one or more of the following criteria while on the multiple daily
> injection regimen:
> (1) Glycosylated hemoglobin level (HbAlc) > 7.0 percent
> (2) History of recurring hypoglycemia
> (3) Wide fluctuations in blood glucose before mealtime
> (4) Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl
> (5) History of severe glycemic excursions
> (B) The patient with diabetes has been on a pump prior to enrollment in
> Medicare and has documented frequency of glucose self-testing an average of
> at least 4 times per day during the month prior to Medicare enrollment.
> REVISED, see above
> Diabetes needs to be documented by a fasting C-peptide level that is less
> than or equal to 110 percent of the lower limit of normal of the
> laboratory s measurement method. (Effective for Services Performed on or
> after January 1, 2002.)
> Continued coverage of the insulin pump would require that the patient has
> been seen and evaluated the treating physician at least every 3 months. The
> pump must be ordered by and follow-up care of the patient must be managed by
> a physician who manages multiple patients with CSII and who works closely
> with a team including nurses, diabetes educators, and dietitians who are
> knowledgeable in the use of CSII.
> 6. Other uses of external infusion pumps are covered if the contractor's
> medical staff verifies the appropriateness of the therapy and of the
> prescribed pump for the individual patient.
> Payment may also be made for drugs necessary for the effective use of an
> external infusion pump as long as the drug being used with the pump is
> itself reasonable and necessary for the patient's treatment.
> John S Wilkinson, Rome, NY
> "A veteran is someone who, at one point in his or her life, wrote a blank
> check made payable to The 'United States of America', for an amount of up to
> and including their life." (Author unknown)
> Be very, very careful what you put into that head, because you will never,
> ever get it out. Thomas Cardinal Wolsey (1471-1530)
> -----Original Message-----
> From: email @ redacted
> [mailto:email @ redacted] On Behalf Of Jeff Gamble
> Sent: Wednesday, July 13, 2011 8:42 PM
> To: email @ redacted
> Subject: [IP] Medicare & Pumping
> August first I have to start Medicare. I am type 2, and use a Ping. Is
> there anyone out there who is insulin dependent type 2 on a pump and
> covered by Medicare. I came down from an A1c of 9 to an A1c of 6 with
> the pump and now it looks like I will have to go back to shots. And
> just when I got used to bolusing .35 units for my 3 carb breakfast.
> Again, I am looking for any way for Medicare supplemental insurance to
> pay for pump supplies for a type 2 diabetic.
> Jeff Gamble
> Big Bay Lighthouse B& B
> 3 Lighthouse Rd
> Big Bay,MI 49808
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