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Subject: [IP] Medicare Geuidelines and HMO's

Thanks for the response to the c-peptide questions I had.  I have found a
medicare website which describes the c-peptide and udated guidelines for
medicare pump appoval. According to these new guidelines, I do qualify with
a c-peptide of.6(revised  5/01)  Here's my question.  I am on medicare but
chose an HMO provider on a medicare+plan.  Does anyone know if these plans
must follow medicare guidelines for medicare covered benefits.
Rosalie
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All HMO's must follow medicare mandated guidelines regardless of Geographic
Location. Call your Local Medicare Intermediary (I think it's 1800-MEDICARE)
or similar, if they try to exclude any covered item Call the Medicare Fraud
Hotline to report them.It does not matter if your State has Mandated
Diabetes coverage. Are you certain you want to be in an HMO??? Look at
Traditional medigap programs. As you get older  Complications are an ever
increasing problem and many HMO's do not offer more than a certain number of
prescriptions, Around here it is 3. I take 12. Given the higher cost of my
POS (Point of service ) plan the cost of my prescriptions fills the gap.  I
also get 300 test strips a month, unlimited pump supplies and 3 vials of
Humulog every 30 days. each for $10. THE PROBLEM IS MEDICARE RULES REQUIRES
YOUR DOC TO SEND THEM PAPERWORK EVERY TIME YOU NEED SOMETHING TO CERTIFY
THAT YOU STILL HAVE DIABETES AND HAVE NOT YET BEEN CURED. As a doctor I
never participated in Medicare (or any Insurance) I opted out of medicare
and saw Medicare patients for a sliding fee scale. Much better than having
them come to your office like the Gestapo (Geheim Stats Polizei) Complete
with Guns Possibly lacking the Leather Trench Coats.
A. L. Bender, M. D.
email @ redacted
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