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Re: [IP] Medicare ALJ case

Phyllis - Medicare denies payment for my supplies (which includes the test  
strips) every time my supplier submits an order. I use between 9-12 strips  
per day. After my Dec. '10 order I received a letter from Noridian  
(Medicare administrator for this area) that an appeal had been submitted by  
the supplier. The letter clearly stated that if the claim was denied I  
would be responsible for payment. Medicare did make the payment but when my  
next order was submitted, Medicare then denied it. Like you, it certainly  
doesn't matter what the doctor has ordered or that I submit my BG test  
results as requested. I know we've had some on IP trying to get Medicare to  
cover CGMS but I think the bigger problem is getting Medicare to just pay  
for the strips we need. With my gastroparesis and hypoglycemia unawareness  
I have a very difficult time maintaining my BG levels. Since my order  
includes both pump & testing supplies I think Medicare would cover the pump  
supplies even if they deny payment for the strips. Keep us informed on what  
happens. I know it may be something I'll have to deal with. Shirley, dx age  
5, 1954 Type 1; Animas 1250; Animas Ping, Chandler AZ

On , Phyllis <email @ redacted> wrote:
> I was wondering if anyone has been through the experience of being denied  
> coverage of payment by Medicare for test strips or any other pump related  
> items. Medicare wants to cover test strips in the amount of 3/day. I have  
> been through 2 appeals and the 3rd will go before an Administrative Law  
> Judge. Medicare had always paid for their allowable amount (in dollars)  
> and just last Fall decided as a pump patient I only need 3 tests/day. The  
> payor in the area I live for test strips is CIGNA. My Endo has sent in  
> what is required, my copies of CareLink reports are included every 90  
> days also. My supplier is doing so much for me; filing what is needed and  
> sending me my supplies. Has anyone had their denial issue go before an  
> ALJ? Wondering what it is like.> Phyllis> dx Type I 1939> pumping for 23  
> yrs> MM522 .
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