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[IP] Re: Medicare and CGM



Andy,

 I hope you never have to face what so many of us have had to deal with:
Medicare regulations that deny CGM coverage! You are fortunate to have found an
exception that somehow provides coverage. I understand that you will not
question a decision that benefits you.

 I have been through four levels of appeal including a Level 3 hearing with an
administrative law judge (ALJ) over this issue. The ALJ and a Level 4 Medicare
appeals judge issued UNFAVORABLE decisions based on NHIC Policy Article A33614
which denies CGM coverage because it is precautionary.

 HR 3710, The Medicare CGM Coverage Act, is an attempt to correct this misguided
policy. If you ever get denied for CGM coverage get back to me and I will offfer
you assistance in filing an appeal. In my case, the insurance company stopped
coverage because under Medicare policy their previous approval was an
administrative error. I hope your coverage is not the result of a mistake.

Jerry Smith
   
--------------------------------------------------------------

On Sun, 2/23/14, email @ redacted <email @ redacted> wrote:

Subject: Re: Medicare and CGM
To: email @ redacted
Date: Sunday, February 23, 2014, 9:56 AM
  
Jerry,
  
 I do NOT have a secondary or pay any 20%. Medicare is solely Fed Funded. I
can't help fight a fight that doesn't exist. "Dear Congress Person, please pass
a bill that's already on the books". Doesn't the US Govt already waste enuff
time & $$!

--------------------------------------------------------------

In a message dated 2/22/2014 12:37:20 P.M. Central Standard Time, 
email @ redacted writes:
 
Andy,
 
 CMS, Centers for Medicare AND Medicaid Services, is the agency that sets policy
for both Medicare and Medicaid. Medicaid funding is shared by both the federal
government and the state. If you moved to another state, you may or may not be
able to get coverage for your CGM system. I am able to receive coverage as a
Medicare recipient because I was able to find a Medicare Advantage plan that
provides CGM coverage as an extra benefit. My co-pay is 20%, which is better
than recipients of regular Medicare who receive zero CGM coverage.
 
It would be great if you would contact your Congress person
and advocate for support of HR 3710, The Medicare CGM Coverage Act. 
This bill may even help you if your state decides to follow Medicare
 regulations and stops covering your CGM system. The proposed bill is very
simple and straightforward. It requires Medicare to consider
CGM components as durable medical equipment (DME)that is medically
reasonable for treatment of some people with insulin dependent diabetes.
 
You have been taken a beating from IP members.  I hope you now understand
 why some have been so frustrated with your posts. IP is there to help and
support its members. You are very fortunate to receive the
 coverage you get for your CGM sensors and equipment. Many IP members are not so
fortunate.
 
It was good to hear from you.  I wish you well.
 
Jerry Smith
.
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