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Re: [IP] Medicare Non-Payment



Nancy asked on Mon, 12 Jun 2006 03:38:05 -0500:
"Just wondering if you got things worked out with Medicare.  Are they  
paying
for your pump supplies yet?  I have a pump and will be going on  
Medicare in
October.  Do you have any tips for me so that I don't have problems  
getting
them to pay for my supplies?"

The defining test is the c-peptide.  It is supposed to determine if  
your are
a type 1 or not  and medicare, knowing more than your doctor, will
pay or a pump and supplies only if you are a type 1.  There are two
problems with this thinking:
1. The c-peptide is a flakey test.  Its interpretation is not as  
clear as
one set of values for type 1 and another for type 2.
2. It is medically unclear that pumps should only be for type 1's.   
Especially
since the definition of type 1 or I or IDDM is an evolving definition.

For me, my alternate insurance, FEP Blue Cross pays what medicare won't.
But the diabetic pharmacy submits the bills to medicare and then when  
they are
refused submits them to Blue Cross.  Oh, by the way, medicare's stated
reason for not paying for pump supplies is because I have not proved
I have a pump.  The actual reason is that they didn't approve getting
the pump. Not stating the real reason for refusal is a bureaucratic  
dodge
aimed at avoiding portraying medicare as making a medical judgement.

Floyd Shipman
email @ redacted
.
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