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Medicare should change policy and cover CGM systems. If anyone is concerned enough about his or her health and has diabetes, why shouldn’t we encourage continuous monitoring? Negotiate a reasonable price point with the manufacturer and provide coverage. This is a no brained guys! C’mon man...
My prescription for Freestyle Libre sensors is being denied by Medicare because of a wrong diagnosis code on the prescription. I can't get any answers from Medicare, Diabetic Supplies, Inc, or Express Scripts, or my Doctor. My diabetes is not being controlled well without proper equipment. This video doesn't supply good information at all.
My husband had one rejected too. Now we must investigate why. I read Pt B should cover, not Pt D. We just paid for it. Hope they reimburse. This should not be this difficult.
@@vickienevels3246 I don't know it is my husband's and he doesn't recall exactly. He said about $100 for the reader but then the thing on the arm is about $200 for 2 and is changed ever 14 days. If I find the receipt I'll let you know for sure.
This video is useless. Medicare does pay for supplies. I think it’s paid under durable medical equipment. Easy your doctor has to order/ prescription. Mail order or pick up a your nearest pharmacy. Some pharmacy chars more for supplies. Walmart brands are cheaper even if you have to pay out of pocket. I use insulin pens so my needles are pretty cheap. Medicare will now pay for the new freestyle Libre. Doctor needs to write a prescription Medicare will need some medical documentation to support the need. I don’t have to prick my fingers anymore. Ask doctor to write script for complete kit. It is easier for elderly people to use. The device can be set up to remind you when to check bs levels. It makes a loud beeping sound. You have to keep it handy and you can check bs anywhere. You wear a sensor on your skin . Change every 14 days it will remind you. You can take a shower it won’t come off. I think they are the best thing since sliced bread. I don’t know if regular insurance covers the device. Good luck
I used CGM for several years (dexcom). This critical equipment was taken away from me when my endocrinologist put me in NEW insulin products for once a day injections and once a week injections AND 3 pill prescriptions including Actose. Medicare immediately cancelled my dexcom cgm. My dexcom cgm made it possible for my A1C to be 6.1. My last A1C was 8.9. I am struggling with insulin resistance as a T2 long time diabetic. I was crushed that Medicare declared me ineligible because I am using newer and far less risky insulin. Why would you cancel me?! Please tell me when I can return to using a dexcom g6. Currently I am constantly checking my blood sugar.
I am with you, I mean in the same boat. they took the CGM away I am brittle, I have had very adverse affects and my primary supports me, but nope. medicare does not support me at all and now I cannot get strips so??? I guess I am supposed to guess when I have high blood sugar. I don't get what they are doing here.
I'm having a hard time even getting a CGM. I just stopped taking Actos after being on it for 5 yrs. I had been having trouble with my legs swelling very badly. For over 1½ yrs I had complained to my PCP NP, my Orthopedic NP and my pain management NP. I would get "yeah that looks painful" or "wow they sure are swollen, are you wearing your support hose daily". One day I complained about them to the Diabetic NP. She said Actos can do that...let's stop it and see if that's it. Well, I lost 14 pounds in 8 days and another 8 pounds in 2 more weeks. My legs haven't swollen since. So watch for weight gain. Because of the drastic weight loss my sugars went out of control. I went from an A1C of 6.3 to 9.6. I now have a second insulin that I take with meals and snacks. I have Raynauds disease which decreases the blood flow to the capularies in your fingertips. Each time I test, I have to fire the injector 2-3 times and then squeeze out some blood to test. Even with this problem they won't pay for a CGM. It's frustrating, I don't understand. It's not like you can stop taking insulin. I'm a T1 and insulin is vital for my life.
If you are a type 1 diabetic, Medicare will absolutely pay for a CGM and an insulin pump. I’m on Tslim insulin pump and Dexcom CGM. Your endocrinologist needs to send supporting documentation such as a required C reactive protein lab test and a record of blood glucose readings for a period of time.
I am having hell, trying to keep my Blood Sugar down, I need something better then pricking my finger, multiple pricks trying to find blood is making me painful fingers, killing my guitar playing! My ACCU-CHEK Nano is wore out. Medicare just keep taking more money, but not helping anybody! 81yrs old, working 50yrs= broken promises! care
You should qualify for a new meter if yours is worn out. I don't see Medicare giving us a good alternative to finger pricking. It's always what iss cheapest and not for the best interest of the person. It is ridiculous that you need decent medical care, but have to receive the cheapest thing around. Or be turned down altogether. Big wrong on their part. Let's see...how much $ did we put into the system over a working lifetime. ? And what do we get for that?
What I just found out was the office visit isn't free if you HAVE diabetes. So Medicare will pay to check people to see if they have diabetes, but not help to control diabetes. Bottom line, This video made me think my screening was covered, but I guess this is government so I shouldn't get dragged in by the BS.
Civil Remedies Division Docket No. C-15-1021 Decision No. CR4596: On April 29, 2016, a judge in Medicare’s Civil Remedies Division struck down the policy that CGMs are precautionary and therefore not durable medical equipment (“DME”) eligible for coverage under Medicare. The judge noted:“The contractor [NHIC] and CMS have not produced any record in the form of peer-reviewed literature, medical opinions, or even an analysis from an individual with a medical background that supports a conclusion that CGM is never reasonable and necessary irrespective of the beneficiary’s condition. . . There is simply no evidence before me that explains how CGM does not meet DME requirements or why CGM cannot ever be reasonable and necessary under [the Medicare Act].” Accordingly, the judge found that the policy statement that CGM is precautionary and therefore not covered under Medicare’s DME benefit to be invalid under the reasonableness standard. The judge reviewed each of the statutory elements for DME and how CGM satisfied those elements. Neither the Medicare contractor nor CMS submitted a single document or proposed a single witness in support of the position that CGM is precautionary.
Hi Kathryn, I have been a type 2 diabetic for several years, I use to be able to get FreeStyle Libre 14 day glucose monitor before I started on Medicare, I currently use Ozempic every saturday and test my sugar 3 to 4 times a day. But because Ozempic is only injected once a week I am denied use of a glucose monitor system. I read and see alot about diabetics, but not about diabetics type 2. How can we get Medicare to support use for the Use of Glucose Monitors vs sticking our fingers 3 or 4 times a day. Is there a site or place we can request a review of this. Just because we inject once we all need to monitor our blood glucose and it is so much easier with the use of a GM. Like you i struggle to maintain my A1C below 7.5. I use to before the loss of my GM. Anybody have help for US.
Was your Ozempic covered? My part D prescription plan is going to charge me $500 in Jan then $45 for next 4 months.. In June I have to pay $260.00 a month for the rest of the year!!
I have type 2 diabetes and Medicare always paid for my 90 days supply of test strips but all of a sudden I'm suppose to pay and I never did before. It's for 3 months they always covered the ultra one strips and now I'm told I have to pay a payment. Does anyone else have to. I just dont understand why i never had to before.
I am still receiving my test stripes and lancet free. Have been for 5 years. I don't know what happened with you but this was a Medicare covered treatment and not my supplement being involved. QUESTION WHY before accepting that you have to pay.😊
Medicare Pt D from Humana will not pay for testing supplies. He needed them and had to pay out of pocket. Insurance is no good if you won't pay when we need you. Smh
@@annarenfroe2943 thanks. I'll further look into this. Husb said strips are free. He pays for lancets. Not sure what he paid for the reader. I know he pays $200+ for that thing he can scan that goes in his arm(forgot its name). That's probably considered luxury.
On May 26, 2015 the Federal Court gave the Secretary the opportunity to correct the “error in the novel” but failed to do so. On Nov 8, 2016 (election day) the Secretary violated Whitcomb’s civil rights by refusing to cover a Continuous Glucose Monitor for the management of Whitcomb’s diabetes will now cost the US Government millions of dollars in damages. In the present matter the Federal Court’ ruling recognizes that government's refusal to cover a Continuous Glucose Monitor for the management of Whitcomb’s diabetes was not supported in law or fact. See Case No. 13-CV-990 Whitcomb v Burwell Secretary of Health & Human Services.
Not understanding why I am not able to get any diabetic supplies even though I qualify is ridiculous. Medicare doesn’t seem do you have any explanation? Why is this system so messed up?
Particular brand of test strips for specific tester I have had provided by Medicare for 12 years are NO LONGER ON APPROVED LIST so I now have to pay for supplies. No information as to "coverage approved" products and if I switch may have to pay for different tester as current one is only 2 years old...Other seniors are encountering same problem....What gives? Calling by phone only means hanging on for 20-60 minutes.
My prescription for Contour Strips was denied because coverage was discontinued, so I asked for a list of approved test strips. I was told that they don't have a list!!! how dumb is that!!
I used to take Contour strips. Then Bayer introduced Contour NEXT strips which are better..not sure why...and have their own test strip meter. I have been using them ever since for years and they are covered by my Medicare....not sure which coverage feature, but i can only get 50 strips every quarter so i buy extras on Ebay. Would like to have continuous monitor but dont think i qualify. My A1c runs about 7.0% quarterly.
I have Medicare originally by having SS disability since I was 62. It was the SS disability that was a problem. You just about have to be in a coma to " qualify " If you're just going on Medicare, you just apply do paperwork thru your state Health and Welfare department. It's H & W in my state, Idaho. I had to get a lawyer to get disability. Sadly.
I think they are free if you qualify, but I'm 84 and have had T2 for over 15 years. Used to test 2x a day, but in recent years Medicare will only pay for 50 strips a quarter so i test once a day and have to buy enough to do that on my own.
You live in this country learn to speak and understand English and stop thinking you are special and should be catered to or you can just go back where you came from and we will look at it as no loss at all!!
Medicare should change policy and cover CGM systems. If anyone is concerned enough about his or her health and has diabetes, why shouldn’t we encourage continuous monitoring? Negotiate a reasonable price point with the manufacturer and provide coverage. This is a no brained guys! C’mon man...
I agree. But they are providing fewer services all the 5ime, citing costs. Medicare is at 5he bottom of the priority list of our lovely government.
what is CGM?
My prescription for Freestyle Libre sensors is being denied by Medicare because of a wrong diagnosis code on the prescription. I can't get any answers from Medicare, Diabetic Supplies, Inc, or Express Scripts, or my Doctor. My diabetes is not being controlled well without proper equipment. This video doesn't supply good information at all.
Can you tell what the incorrect diagnosis code is and what the correct code should be?
My husband had one rejected too. Now we must investigate why. I read Pt B should cover, not Pt D. We just paid for it. Hope they reimburse. This should not be this difficult.
@@MSHARLEYDWOKEAF Mine is also being denied. My Dr said I could just buy one. If you don't mind sharing how much did yours cost?
@@vickienevels3246 I don't know it is my husband's and he doesn't recall exactly. He said about $100 for the reader but then the thing on the arm is about $200 for 2 and is changed ever 14 days. If I find the receipt I'll let you know for sure.
This video is useless. Medicare does pay for supplies. I think it’s paid under durable medical equipment. Easy your doctor has to order/ prescription. Mail order or pick up a your nearest pharmacy. Some pharmacy chars more for supplies. Walmart brands are cheaper even if you have to pay out of pocket. I use insulin pens so my needles are pretty cheap. Medicare will now pay for the new freestyle Libre. Doctor needs to write a prescription Medicare will need some medical documentation to support the need. I don’t have to prick my fingers anymore. Ask doctor to write script for complete kit. It is easier for elderly people to use. The device can be set up to remind you when to check bs levels. It makes a loud beeping sound. You have to keep it handy and you can check bs anywhere. You wear a sensor on your skin . Change every 14 days it will remind you. You can take a shower it won’t come off. I think they are the best thing since sliced bread. I don’t know if regular insurance covers the device. Good luck
So is this the truth? and where does Medicare have this policy written?
I used CGM for several years (dexcom). This critical equipment was taken away from me when my endocrinologist put me in NEW insulin products for once a day injections and once a week injections AND 3 pill prescriptions including Actose. Medicare immediately cancelled my dexcom cgm. My dexcom cgm made it possible for my A1C to be 6.1. My last A1C was 8.9. I am struggling with insulin resistance as a T2 long time diabetic. I was crushed that Medicare declared me ineligible because I am using newer and far less risky insulin.
Why would you cancel me?! Please tell me when I can return to using a dexcom g6. Currently I am constantly checking my blood sugar.
Kathryn, did you have Original Medicare & a Medicare Supplement OR did you have Medicare Advantage Plan when "cancelled"? Hope you see/get this....
I am with you, I mean in the same boat. they took the CGM away I am brittle, I have had very adverse affects and my primary supports me, but nope. medicare does not support me at all and now I cannot get strips so??? I guess I am supposed to guess when I have high blood sugar. I don't get what they are doing here.
I'm having a hard time even getting a CGM. I just stopped taking Actos after being on it for 5 yrs. I had been having trouble with my legs swelling very badly. For over 1½ yrs I had complained to my PCP NP, my Orthopedic NP and my pain management NP. I would get "yeah that looks painful" or "wow they sure are swollen, are you wearing your support hose daily". One day I complained about them to the Diabetic NP. She said Actos can do that...let's stop it and see if that's it. Well, I lost 14 pounds in 8 days and another 8 pounds in 2 more weeks. My legs haven't swollen since. So watch for weight gain.
Because of the drastic weight loss my sugars went out of control. I went from an A1C of 6.3 to 9.6. I now have a second insulin that I take with meals and snacks. I have Raynauds disease which decreases the blood flow to the capularies in your fingertips. Each time I test, I have to fire the injector 2-3 times and then squeeze out some blood to test. Even with this problem they won't pay for a CGM. It's frustrating, I don't understand. It's not like you can stop taking insulin. I'm a T1 and insulin is vital for my life.
If you are a type 1 diabetic, Medicare will absolutely pay for a CGM and an insulin pump. I’m on Tslim insulin pump and Dexcom CGM. Your endocrinologist needs to send supporting documentation such as a required C reactive protein lab test and a record of blood glucose readings for a period of time.
This video does not provide the substantive info patients need to find covered suppliers for approved DME
Yep, the video is just a waste of time.
I am having hell, trying to keep my Blood Sugar down, I need something better then pricking my finger, multiple pricks trying to find blood is making me painful fingers, killing my guitar playing! My ACCU-CHEK Nano is wore out. Medicare just keep taking more money, but not helping anybody! 81yrs old, working 50yrs= broken promises!
care
You should qualify for a new meter if yours is worn out. I don't see Medicare giving us a good alternative to finger pricking. It's always what iss cheapest and not for the best interest of the person. It is ridiculous that you need decent medical care, but have to receive the cheapest thing around. Or be turned down altogether. Big wrong on their part. Let's see...how much $ did we put into the system over a working lifetime. ? And what do we get for that?
try and use the side of finger for sticking it is a lot less painful
What I just found out was the office visit isn't free if you HAVE diabetes. So Medicare will pay to check people to see if they have diabetes, but not help to control diabetes. Bottom line, This video made me think my screening was covered, but I guess this is government so I shouldn't get dragged in by the BS.
Civil Remedies Division Docket No. C-15-1021 Decision No. CR4596: On April 29, 2016, a judge in Medicare’s Civil Remedies Division struck down the policy that CGMs are precautionary and therefore not durable medical equipment (“DME”) eligible for coverage under Medicare. The judge noted:“The contractor [NHIC] and CMS have not produced any record in the form of peer-reviewed literature, medical opinions, or even an analysis from an individual with a medical background that supports a conclusion that CGM is never reasonable and necessary irrespective of the beneficiary’s condition. . . There is simply no evidence before me that explains how CGM does not meet DME requirements or why CGM cannot ever be reasonable and necessary under [the Medicare Act].” Accordingly, the judge found that the policy statement that CGM is precautionary and therefore not covered under Medicare’s DME benefit to be invalid under the reasonableness standard. The judge reviewed each of the statutory elements for DME and how CGM satisfied those elements. Neither the Medicare contractor nor CMS submitted a single document or proposed a single witness in support of the position that CGM is precautionary.
if you need that i can help you to get covered through part B
@@ryanadams3230 I would appreciate your help. I am currently be denied for this reason
Hi Kathryn, I have been a type 2 diabetic for several years, I use to be able to get FreeStyle Libre 14 day glucose monitor before I started on Medicare, I currently use Ozempic every saturday and test my sugar 3 to 4 times a day. But because Ozempic is only injected once a week I am denied use of a glucose monitor system. I read and see alot about diabetics, but not about diabetics type 2. How can we get Medicare to support use for the Use of Glucose Monitors vs sticking our fingers 3 or 4 times a day. Is there a site or place we can request a review of this. Just because we inject once we all need to monitor our blood glucose and it is so much easier with the use of a GM. Like you i struggle to maintain my A1C below 7.5. I use to before the loss of my GM. Anybody have help for US.
Was your Ozempic covered? My part D prescription plan is going to charge me $500 in Jan then $45 for next 4 months.. In June I have to pay $260.00 a month for the rest of the year!!
I have type 2 diabetes and Medicare always paid for my 90 days supply of test strips but all of a sudden I'm suppose to pay and I never did before. It's for 3 months they always covered the ultra one strips and now I'm told I have to pay a payment. Does anyone else have to. I just dont understand why i never had to before.
I am still receiving my test stripes and lancet free. Have been for 5 years. I don't know what happened with you but this was a Medicare covered treatment and not my supplement being involved. QUESTION WHY before accepting that you have to pay.😊
Medicare Pt D from Humana will not pay for testing supplies. He needed them and had to pay out of pocket. Insurance is no good if you won't pay when we need you. Smh
Medicare part B is supose to cover it
Yes. That's Medicare for those supplies. Not your supplement ins.
@@nothingness405 thanks. Our Humana is not supplemental. It's a prescription drug plan(Medicare Pt D).
@@annarenfroe2943 thanks. I'll further look into this. Husb said strips are free. He pays for lancets. Not sure what he paid for the reader. I know he pays $200+ for that thing he can scan that goes in his arm(forgot its name). That's probably considered luxury.
I need to find out which brand of blood sugar monitoring is covered.
Insulin very expensive on Medicare also CGM Any help with info
Super happy with the information received and service rendered.
On May 26, 2015 the Federal Court gave the Secretary the opportunity to correct the “error in the novel” but failed to do so. On Nov 8, 2016 (election day) the Secretary violated Whitcomb’s civil rights by refusing to cover a Continuous Glucose Monitor for the management of Whitcomb’s diabetes will now cost the US Government millions of dollars in damages. In the present matter the Federal Court’ ruling recognizes that government's refusal to cover a Continuous Glucose Monitor for the management of Whitcomb’s diabetes was not supported in law or fact. See Case No. 13-CV-990 Whitcomb v Burwell Secretary of Health & Human Services.
Not understanding why I am not able to get any diabetic supplies even though I qualify is ridiculous. Medicare doesn’t seem do you have any explanation? Why is this system so messed up?
Particular brand of test strips for specific tester I have had provided by Medicare for 12 years are NO LONGER ON APPROVED LIST so I now have to pay for supplies. No information as to "coverage approved" products and if I switch may have to pay for different tester as current one is only 2 years old...Other seniors are encountering same problem....What gives? Calling by phone only means hanging on for 20-60 minutes.
I'm in the same situation. Where is their formulary? Were you able to find it?
My prescription for Contour Strips was denied because coverage was discontinued, so I asked for a list of approved test strips. I was told that they don't have a list!!! how dumb is that!!
I used to take Contour strips. Then Bayer introduced Contour NEXT strips which are better..not sure why...and have their own test strip meter. I have been using them ever since for years and they are covered by my Medicare....not sure which coverage feature, but i can only get 50 strips every quarter so i buy extras on Ebay. Would like to have continuous monitor but dont think i qualify. My A1c runs about 7.0% quarterly.
Can you help me on how to register on medicare... thanks
I have Medicare originally by having SS disability since I was 62. It was the SS disability that was a problem. You just about have to be in a coma to " qualify " If you're just going on Medicare, you just apply do paperwork thru your state Health and Welfare department. It's H & W in my state, Idaho. I had to get a lawyer to get disability. Sadly.
Pointless bullshit from 7 years ago. Shit has changed!
I'm new here, what do you mean shit has changes. Does that mean they stopped providing or they are providing.
I am considering a lawsuit against Medicare, as this video has no sub titles, and I am almost completely deaf. Could they be any more insulting?
If you click on the CC button on the bottom - right of the video (mouse over) it provides Close Captioning.
I tried it out and it does work. Cheers.
Does original Medicare pay for diabetic supplies?
Yep, as long as your doctor prescribed it.
I would like to know why cvs is charging for diabetic test strips when they are supposed to be free
I think they are free if you qualify, but I'm 84 and have had T2 for over 15 years. Used to test 2x a day, but in recent years Medicare will only pay for 50 strips a quarter so i test once a day and have to buy enough to do that on my own.
Useless
Yes, the video is totally useless.
Español
You live in this country learn to speak and understand English and stop thinking you are special and should be catered to or you can just go back where you came from and we will look at it as no loss at all!!