[Diabetes-talk] TCOYD Medicare Appeals Program

[blindhands at aol.com]

That is what this is about.  I am OK to get a pump, but Medicare will not
cover the CGM or the supplies needed for the CGM.   My insurance [United
Health Care] goes along with Medicare rules]  

There is no guarantee that any who participates in this will get any thing.
The coverage for an attorney who will represent you alone to fight for
Medicare to cover the CGM & supplies needed is the purpose of this.  You
need to agree whatever comes out of this that you will let them join your
name to the list that will go forward to bring the attention for the need of
this. 

The facts are the new pumps coming out within the next year need CGM to work
to it's fullest potential.

  They are hoping  to find 50 folks to go forward with this.  They don't
have a lot right now and they did just drop one of the criteria  which from
what you just said, would not be an issue[the fact you had insurance that
did cover it & now you have Medicare, that won't cover it].

So reach out and find out.  If you call them up they will ask you to fill
out the application, which is answering questions about your diabetes.

Joyce Kane
-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Tam via Diabetes-Talk
Sent: Thursday, November 3, 2016 9:58 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Tam <Fidano at comcast.net>
Subject: Re: [Diabetes-talk] TCOYD Medicare Appeals Program

I am not interested in a pump, again at this time.. but did get on the
Dexcom this year, but now divorced, cobra will cover but medicare will
not...  any of this help with getting  CGM on medicare coverage?


-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
blindhands--- via Diabetes-Talk
Sent: Friday, October 14, 2016 12:08 PM
To: 'Diabetes Talk for the Blind'
Cc: blindhands at aol.com
Subject: [Diabetes-talk] TCOYD Medicare Appeals Program

Check this out

https://tcoyd.org/resources/cgm.html?utm_source=streamsend&utm_medium=email&
utm_content=27577885&utm_campaign=September%20E-Update%20from%20TCOYD

I filled this out and spoke to these folks besides sending in my paper work
to them.  When I spoke to them less than 2 weeks back they told me I did not
qualify.  There is a list of requirements on this website.  The only one I
could not answer "yes" to was:

2. Have had private health insurance coverage for CGM before transitioning
to Medicare.

After our chat and my comments to them.  Apparently, they had a meeting with
the lawyer  and they removed the above requirement.

I have been asked to be part of this action.  They are waiting on one more
letter from me and I need to get a copy of my second denial for coverage
from the insurance company.   

They are hoping to have 50 diabetics in this action[not sure if that is what
it is called] and they don't have that many yet.  This is only the beginning
so they will continue looking for people to be part of this.

I will say that when I first went down this road looking into using a pump,
Medtronic's person that handles the insurance end of it told me Medicare
would not cover it and wanted to just submit the paper work for the pump.
Since this pump works with the CGM I felt it wasn't what I needed.  I needed
something that would be able to detect my low blood sugars and do something
like notify someone, do something like a sound loud enough to stimulate
me/wake me up enough so I could react and try to correct it.  This pump not
only makes a sound, but it makes the sound when you are getting low and it
will turn off giving you insulin when it hits a certain level for up to 2
hours.  I have been passed out on the floor for 3 to 4 hours before I have
been found.  I live alone.  If I left it up to Medtronic's, I would not have
had the 2 denials from the insurance company.  

I did some research and calling to ask how and why and for advice and I need
to say the American Diabetes Association here in CT is where I got
information on what to do.  They put me in touch with an advocator that
works for the state of CT and she became involved.  She actually helped with
submitting the paperwork for the second denial.  She also explained and
advised the last step for getting a judgement from a judge.    At that point
without a lawyer it was suggested not to go any further.  I have contacted
her since the denial to get some of the copies of what was submitted from
her so I could send that in to be considered for this TCOYD Medicare Appeals
Program.

I am hoping to bring some awareness to the pump, CGM, blood glucose meter
companies about making these things more accessible to the Visually
Impaired/Blind. 
Joyce Kane
Blindhands at aol.com


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