Replies to This Discussion

Permalink Reply by Zoe on June 6, 2011 at 4:15pm

Interesting! Doesn't the c-peptide of Type 2's also decrease over time when their pancreas finally stops producing much of its own insulin (I thought that was the reason Type 2's are put on insulin eventually). I wonder if Medicare would pay for a Type 2 who didn't produce much insulin anymore? Maybe I shouldn't try to make Medicare rules make sense. I worked for County BH for a few years, where I thought of myself as working for Behavioral Health clients not for "the government". Every once in awhile I would ask a coworker what sense a certain county regulation made. Her answer was often, "Zoe, it's the government" which explained everything. (or not)

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Permalink Reply by MossDog on June 6, 2011 at 4:22pm

Yes Medicare will pay for pump/supplies for anyone that meets the above guidelines regardless of Type.

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Permalink Reply by Betty J on June 6, 2011 at 4:28pm

I saw a post a few years ago from someone who was T2 who said that Medicare would not pay for a pump because they were T2....good that things have changed.

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Permalink Reply by Zoe on June 6, 2011 at 4:43pm

Ok, thanks, Moss, that makes more sense.

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Permalink Reply by MossDog on June 6, 2011 at 4:53pm

Another part to this is if you are positive for autoantibodies it makes no difference whatsoever what your c-peptide is you are covered.

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Permalink Reply by Kelly WPA on June 6, 2011 at 4:59pm

If you read the requirements on the CMS site, you have to meet the c-peptide requirements - it is not an either or thing and states they must be met.

Permalink Reply by MossDog on June 6, 2011 at 5:05pm

If you look one sentence before what you cut and pasted above you will see:

The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement, or, as an alternative, must be beta cell autoantibody positive.

Permalink Reply by Kelly WPA on June 6, 2011 at 5:12pm

You are right Mossdog! Sorry, I did not see the "or" - I have always heard it had to be the c-peptide regardless of anything else. Sorry abou that@

Permalink Reply by Brian (bsc) on June 6, 2011 at 5:12pm

Actually, the problem is that the guidelines are written biased for a type 1. A type 2 who may be severely insulin resistant may have "relatively" almost no beta cell function left, but the same "absolute" guidelines are applied. To be consistent the guidelines should scale the c-peptide levels, if you can't eat a 15 g carb meal without going over 200 mg/dl at 2 hrs then you are insulin deficient. Yet the c-peptide levels are scaled for a person with normal insulin resistance, not for a person with insulin resistance.

I have some insulin resistance. I would be seriously challenged to qualify for a pump, let alone a CGMS with the current system.

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Permalink Reply by MossDog on June 6, 2011 at 5:20pm

Unfortunately there is still yet to be ANY guidelines from Medicare to get a CGMS. My personal opinion on this is Medicare should decide whether or not they cover something and the rest should be up to the prescribing Doctor and the Patient.
Not saying anything about your particualr situation but I know quite a few Type 2's on Medicare who were able to get a pump.

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Permalink Reply by Brian (bsc) on June 7, 2011 at 5:20am

In my opinion, we should not be letting Medicare establish medical guidelines. What medicare decides establishes what insurance covers and that becomes the defacto medical guideline. It is a sad state of affairs.

Permalink Reply by MossDog on June 7, 2011 at 4:27pm

But why is it the defacto medical guidance? How can we stop the other insurance companies from following?
Although generally I agree, in my area the Type 2's that have private insurance for the most part do not have to submit to a c-peptide to get coverage on a pump.

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