[Diabetes-Talk] Oh insurance mess!
G melconian
gmelconian619 at gmail.com
Wed Feb 1 18:41:20 UTC 2017
Veronica, I understand your frustrations. When I was trying to get the
dexcom they wer trying to sell me on a full dexcom and pump package when at
the moment I did not need one and I was fine with just getting the dexcom
and doing what I was doing with the different meds and insuin that I was
on. So I totally understand these companies either up sel or have
incompinatne people who have no clue about these sort of matters.
-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Veronica Elsea via Diabetes-Talk
Sent: Wednesday, February 1, 2017 9:43 AM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Veronica Elsea <veronica at laurelcreekmusic.com>
Subject: Re: [Diabetes-Talk] Oh insurance mess!
Joyce, I will be interested to see how you get on with all the bells and
whistles. As for mine, the Animas Vibe has a CGM Dexcom G4 built into it,
although I have no intention of using it because I'm already using the
Dexcom G5 Mobile. But this pump has other features that I believe I can
access so I chose this pump. Can't wait to see what happens the first time I
try to order Dexcom supplies on this insurance. With the help of my "buddy"
at Animas, I got the information to my endocrinologist about the pier to
pier review that is the first step of an appeal. Now I just have to sit on
her to make the phone call. I'm guessing that the insurance people looked at
my numbers and said I wasn't low enough to go on a CGM. And nobody bothered
to tell them that those numbers were gotten while using the Dexcom. I don't
see why I should have to submit numbers at all when my reason for getting a
new pump was that my current pump died. I mean really?
Veronica
"Guide Dogs, First Hand", Veronica Elsea's classic album is now available on
iTunes, along with other music from her and from the Guide Dog Glee Club.
To learn more, visit:
http://www.laurelcreekmusic.com
Veronica Elsea, Owner
Laurel Creek Music Designs
Santa Cruz, California
Phone: 831-429-6407
-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
blindhands--- via Diabetes-Talk
Sent: Tuesday, January 31, 2017 9:11 PM
To: 'Diabetes Talk for the Blind'
Cc: blindhands at aol.com
Subject: Re: [Diabetes-Talk] Oh insurance mess!
Veronica,
Veronica
Clarify for me please, they refused the pump or the Dextron or both?
I am still waiting to hear back from the judge for my appeal for the CGM,
but in less then 24 hours after I participated in my appeal, CMS[Central
Medicare Servicesor whatever they call themselves] made statement that The
Dextron 5G will be covered. I understand the lawyer that represented me
hand turned in requests for coverage for other cases she is handling for
Dextron 5g CGM. They have not heard anything as of yet and that was almost
3 weeks ago.
I am due to go on my Mini Medtronic 530G pump on Feb. 13. They have really
dragged out this training. Of course the trainer took time off for the
holidays and is away for a training session this week. So I have 1 more
training session next Friday & start on the pump Monday.
I did get the Medtronic 630 pump shipped out as if you remember they did
not do a great job in showing me and explaining much regarding these both
pumps. Well after really comparing both of them, the older one was much
better as it works with the IPhone and the new one does not have any IPhone
capability. So I traded in and got the Mini Medtronic 530 pump. Untill I
get on using it that will be the push to learn all the bells and whistles.
No afficial word, but the rumor has it that Medtronics got the FDA approval
for the 670 pump which is being called the "artificial pancreas" due out in
Spring[not that far away].
According to the folks in Medtronics that their CGM will also come under
this decision of CMS, but that isn't clarified as of yet.
The word is that even the fact CMS has made this decision, Medicare doesn't
move quickly to do much and until Medicare comes up with a billing code and
the paperword goes through them with that code, presently they will deny
coverage.
I will wait to either hear when and if the judge approve or deny the CGM.
She was suppose to have a reply back in 90 days from the time the lawyer
submitted the papers for this appeal. That date was January 26, 2017 that I
should of heard back from the judge.
Just a comment: I felt really good about my testimony and what the lawyer
had prepared. The insurance company representing United Health Care was
just repeating, "They go by Medicare rules." She did not answer direct
questions from my lawyer. I felt good when the judge asked the Insurance
Company Representative, "Are you a Type 1 diabetic? Her answer was, She is
a type 2 Diabetic. The judge told her maybe she needs to ask me about not
feeling blood sugars dropping without any signs.
Big disappointment when theI asked the judge what happens now:
She said that I provided all the information I needed to and if I received a
denial from her, then she asked my lawyer, Well you will represent Mrs. Kane
for the next part?
The CMS was discussed during the appeal and I was confused and was able to
ask what the CMS was.
So I am still waiting to see if I get anything from the judge. I think I
deserve something back from the judge to explain what I do.
Joyce n
e
:et the Medtronic 630 pump,
-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Jamie Gurganus via Diabetes-Talk
Sent: Tuesday, January 31, 2017 3:21 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Jamie Gurganus <jamielgurganus at gmail.com>
Subject: Re: [Diabetes-Talk] Oh insurance mess!
Veronica,
I'm so sorry to hear this. I think you should appeal this decision,
since it is the only pump that is the most accessible for the blind. After
18 years of using Accucheck pumps, I was forced to find another pump when
Roche decided to stop distributing their pumps in the U.S. After visiting
with my diabetic educator, playing with the three available pumps and
finding the Diabetes Talk site to ask other diabetics who are blind, I came
to the conclusion that the Vibe was the best option. I also use a Dexcom,
but I don't have it paired with the pump. I like using the iPhone Share app
that allows me to know what my blood sugar is. Pairing it with the Vibe
would be useless for me and would mean that I would have to input blood
sugars in to both the Dexcom and pump to calibrate it twice a day. I'm
lucky that my kids are accessible every morning and night to put a blood
sugar in to the Dexcom, and I didn't find a need to also use the pump for a
receiver. My insurance company did not have any issues with me getting a
new pump, since my Spirit pump's warranty had expired a year ago. I did
have to provide a month's worth of blood sugars showing that I tested at
least four times aday. Isn't that crazy? Anyway, I sure hope you can
appeal and argue your case for the Vibe. It really is a shame that
insurance would keep you from obtaining the only pump that a blind person
can use with limited sighted assistance. I'm just two weeks in to using my
Vibe, and I'm still struggling to learn how to do what I used to do so
easily on my Spirit. I am fortunate to have two teenagers living with me to
help me when it doesn't do what I wanted it to do. But, I can easily give
myself a bolus using the audible bolus feature. Even though the Vibe
doesn't have audible beeps to let me know that I've depressed a button, the
buttons do make a slight click sound once you press them. So, that part is
nice. It is just learning how to blindly navigate a whole new set of menus.
Good luck, and please consider appealing the decision. You shouldn't have
to go back to injections after being on a pump.
Jamie
-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Veronica Elsea via Diabetes-Talk
Sent: Tuesday, January 31, 2017 1:04 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Veronica Elsea <veronica at laurelcreekmusic.com>
Subject: [Diabetes-Talk] Oh insurance mess!
Hi everyone!
I just found out that my insurance company denied coverage for the Animas
pump. Oops! This is what's wrong when the patient isn't involved in filling
out any of the forms. I had tried to get the Vibe and I'm pretty sure that
they denied the coverage because of the Dexcom half of the pump, which I
wouldn't need. Hahahaha, you fools, I already have it. But my endo couldn't
lift a little finger and say on the forms that I had the Dexcom and wanted
this pump because it was more useable by me. I can actually kind of do a
correction bolus on the Vibe, but definitely not on the Ping. And forms
being returned numerous times drew the process out so that I now have only a
couple of cartridges left. Yikes! My endo told me just to go off the pump.
Yeah right! So now I'm trying to get supplies for my Cozmo and hope that my
50 dollar E-bay wonder hangs in there for awhile. I was really hoping to do
the pump switch now, rather than in a couple of months when I'm scheduled
for a surgery that will mess up my life style for quite awhile. And later
this week I'm supposed to get a steroid injection which means I'll go
through my last couple of cartridges faster too.
Of course, were I sighted none of this would be going on because this isn't
the pump I'd be getting. Anyway, I know there isn't anything any of you can
do but I appreciate you letting me rant a bit in the hope that I might get
another idea. But it's multiple factors here. Insurance companies are, well,
who they are. Doctors are in a hurry and just fill out forms without
attention to the person they affect.
And the other stupid thing, ummm, ahem, this one was mine! Two weeks ago I
traveled and took my backup pens with me. I accidentally left them in the
hotel refrigerator. And when I called the hotel, nothing. Oops! So boy am I
stuck for now. Let the fun begin. Sheesh!
Veronica
"Guide Dogs, First Hand", Veronica Elsea's classic album is now available on
iTunes, along with other music from her and from the Guide Dog Glee Club.
To learn more, visit:
http://www.laurelcreekmusic.com
Veronica Elsea, Owner
Laurel Creek Music Designs
Santa Cruz, California
Phone: 831-429-6407
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