Re: [IP] Re: Anyone have Medicare as a 2nd insurer?
"DWStevens" <email @ redacted> writes:
>When you reach the golden 65, Medicare should become your main
>insurance (least here in Texas it does) Medicare will then 'rent' you a
>pump and cover 80% of ALL supplies, -- That includes insulin---. If
>you havea Medicare supplement (i.e. AARP) it will pick up the
>additional 20%. ---- There are a few advantages of getting old:) At
>the end of 4 years, the pump is yous and the supplies are still
>covered. ( Guess that if you drop dead during the 4 yrs, Medicare is
>not left holding a bunch of pumps!!!! OR!!! maybe Medicare 'thinks'
>you will die and not need a pump in 4 yrs?????? :)
>Either way it is a pretty good deal.
A good deal indeed, unless you are a type 2 diabetic. If you are type
2, Medicare won't even cover your supplies if you already have a pump.
I am a type 2 diabetic with ESRD. Well, Medicare kicks in after 3
months on Dialysis, just as if you had turned 65. Medicare becomes
your primary insurance, and I picked up a Medicare Supplement to pay
for the other 20% of everything. Problem is, if you have a C-Peptide
over 0.5, they don't consider you for Insulin Pump Therapy. They won't
even pay for supplies if you already have a pump (which I did from my
previous insurance) My c-peptide is actually artificually elevated
from some type 2 drugs I take but even without the drugs, it is still
way too high for them.
Anyone have any experience in successfully appealing a situation like
this? Surely I can't be the only Type 2 on Medicare trying to get a
Pump or Pump Supplies covered.
Any help will be nmost appreciated.
Steve & Jem
email @ redacted
Type II- 1981, Insulin dependant - 1993, Pumping (MiniMed 508) - 7/01
"As we brushed past each other, you favored me with a smile.
It's okay if we never meet again. I'm lucky you were here just for a while!"
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