To anne re: medtronics

[Guest guest]

Anne I accidently deleted the post so I am sorry if I repeat a point that you

already explained. I am a pump user and have a medtronics pump. My present

pump was paid under private insurance. When I went on medicare I had a hard

time getting my supplies covered. It took 6 months and 3 appeals by medtronics.

Now I have no problem.

You mentioned that you have private insurance and medicare. Your private

insurance is primary and medicare is secondary. If your primary will not cover

the pump and supplies, my experience has been that it is harder to get medicare

to do it, specially when they are secondary.

I saw the problem with people who had private insurance and medicare over the

years I worked in social services. So when I became eligible for medicare I had

my husband drop me from his insurance (blue shield). Since I was over 50, I got

an AARP supplement. It cost me 1/2 the total price to have medicare and a

supplement as compared to what my husband paid for me to be on his insurance.

One of the problems with having medicare and private insurance is that medicare

rarely has to pay anything. A decent private insurance covers most. So in

effect you are paying for medicare (since they take it out of your SSD) and not

getting much use out of it.

Your bill of over $7,000 sounds like they are billing you for the pump too? I

know my supplies run about $400 something for 3 months.

One last point I wanted to in part is that medicare requires a peptide c

something test to approve covering pump supplies. I didn't need this for the

private insurance. it is a test that measures your insulin production levels in

the pancreas. Did you get that test done? Another requirement for medicare is

that you have to have been on insulin injections for I think it was 6 months

prior to getting an insulin pump.

I have not gotten to the point of needing a new pump yet. I am sure it will be

a battle with medicare. I heard they approve new pumps only after 4 years or

more. My private insurance paid for one every 3 years. I am on my second pump.

Have you gotten anything from the private insurance as to why the bill was not

covered? they should have sent you a letter and explained your right to appeal.

I hope this is of some help. I know how horribly frustrating it all is. It is

sad that we have to jump through such hoops to get what we needed to maintain so

level of good health.

Big gentle hugs, Tami Feel free to e mail me if you just need to talk or vent.