Medicare Hassle Pump supplies

Type1Lou
By Type1Lou Latest Reply 2014-07-27 12:32:12 -0500
Started 2014-07-25 18:12:57 -0500

I became eligible for Medicare on June 1, 2014. I use an insulin pump and had been receiving 4 boxes of 10 each infusion sets and reservoirs for my pump. Yesterday I heard from my pump reservoir and infusion set supplier (Medtronic) that they are shipping my refill order but Medicare will only permit them to send me 3 boxes of 10 infusion sets. They can still send me 4 boxes of the reservoirs. I usually change out my infusion set and reservoir every 3rd day but, there are times when an infusion set/reservoir needs to replaced earlier. Yesterday, in fact, I had changed my set and reservoir before breakfast, ate the same breakfast I have every morning, bolused for it and when I tested 2 hours later, my BG was 242. I bolused again and by lunchtime, it was 251! That meant that my insulin wasn't being received and absorbed properly, requiring a change of sets immediately. It doesn't happen often but has occurred 4 times in the past 6 months. With the 30 sets allowed for 90 days by Medicare, there is no wiggle-room for replacing sets that become occluded. Also, it is illogical to permit 4 boxes of reservoirs and only 3 boxes of infusion sets since they must be changed together. (The reservoirs cost $25 per box vs the infusion sets are around $100/box.) While the 3 boxes will just cover me for 90 days providing I have no problems whatsoever, per my experience, this is an unrealistic expectation. What I will probably do, is pay for an extra box on my own every now and then to have a back-up supply and ensure that I have the means to maintain control of my diabetes. This is another example of the penny-wise, pound-foolish approach to our healthcare.


8 replies

lcf74
lcf74 2014-07-26 22:57:56 -0500 Report

Ask your doctor to write a script for what you normally had been getting. I test 7 times a day and they let me do that but have to have a letter from my endo and have to mail a log twice a year. It might make a difference. So afraid my doctor might retire and he is not taking anymore Medicare patients.

Type1Lou
Type1Lou 2014-07-27 12:32:12 -0500 Report

I successfully fought the battle about test strips earlier in June to continue testing 8 times a day. I obtained the pre-authorization needed after 12 days of back and forth between my endo and my insurer. The pre-authorization will need to be renewed every calendar year. This newest hassle is about the pump supplies. While 30 infusion sets (the 3 boxes allowed by Medicare) will take me through 90 days, provided I have no problems with the infusion set after insertion (like bent canulas or hitting a blood vessel), it does not allow for earlier replacement of the infusion set when necessary. One way around it would be to ask my doctor write the scrip saying I replace the infusion set every 2 days instead of every 3 days but I'm loathe to do so…too honest for my own good, I guess.

jayabee52
jayabee52 2014-07-25 18:38:32 -0500 Report

Sorry, Lou, to hear of your medicare difficulty. Usually gov't will do that to us. Or we could say as they did in WW2 "Situation normal, all fouled up" (SNAFU).

I'd better stop there or I'll go on a rant about healthcare in general and the shape our nation is in right now. But that is another topic for a altogether different forum.

James

mustangpeg
mustangpeg 2014-07-25 18:33:11 -0500 Report

I too become eligible for medicare in Jan. After all the problems you are experiencing with them I am scared. Do you know if Medicare will pay for the cost of an insulin pump. I have insurance now but they don't want to cover full cost because I have a $4000.00 deducible that I haven't met yet so am wondering if I should wait and have Dr. order it when I go on Medicare. I was also wondering about the cost of supplies and if they cover the cost of insulin and if they do how much. The thought of relying on the government for my health care scares me even more.

Type1Lou
Type1Lou 2014-07-25 19:30:26 -0500 Report

It is my understanding that pumps are covered under Medicare Part B and subject to a 20% copay but, please give Medicare a call and verify that since I'm just working on my recollection. There may also be a deductible but I'm not certain. I've been using a pump since 2011 and hope I never have to go back to injections!

mustangpeg
mustangpeg 2014-07-25 19:44:44 -0500 Report

I hear you. I am doing 5 injections a day and really want the pump. For convenience and better control.Everyone that has the pump has told me that their only regret is not doing it sooner. They wanted to put me on pump in 2010 but I was still in denial and very scared of the thing. Now I have come to grips with this nasty disease and have done my research on the pump and am more than ready. But now I have the cost factor to deal with. But thanks for the info.

Type1Lou
Type1Lou 2014-07-26 18:53:06 -0500 Report

Prior to Medicare, each year I would have to pay the entire cost of my first 90 day refill of infusion sets and reservoirs. It was a hefty $600 cost and did go towards my annual deductible. I would love to use a CGM since I still struggle with high fasting BG's but Medicare doesn't cover CGM's at all and they are also very costly.

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