Following Medicare guideline "strictly" by Liberty Medical

A weird thing today. I called Liberty Medical for new pump supplies (overdue really) and they asked the usual question of when I had seen my endo last and I made the mistake of telling the truth. It was August 30. So she said she could not send the supplies because today was the last day I should have seen my dr. I said the last time I saw my endo on day 90, Medicare refused to pay for the A1c because 90 days was within the 90 day time frame. So I made sure this time that my appt was after the 90 days, on December 4. Which was when there was an opening after my day 90. [for those not on pump, Medicare pts must see dr q 90 days to keep getting pump supplies]
I had to then say, oh, how about my primary doc? So, a quickly found visit (!) to my primary in September did the trick for supplies.

If I go on day 89 or 90, Medicare won't pay for the lab tests but if I go outside 90 days, I am not in compliance with Medicare guidelines according to Liberty Medical and they get goofy about my supplies. And my endo "ate" that visit I had on day 90 because he did not bill me for it. I found the info in the insurance papers sent to me. I have avoided this in the past and will in the future. Today I must not have had my head on straight when I called Liberty.

I don't know if anyone else has run into this problem. Just wanted to put this out there and don't expect any replies. I just thought this was beyond the pale. I can't even suggest being careful with what date you give re your last dr visit!! My endo says they actually check from time to time. That I don't know for sure, but he said he had had occasional calls. Not about me per se, but some patients. Probably a random sample. i go every 3 months but it is not possible to get exactly on day 90 or 91 with the dr schedule.

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I am completely baffled why those of us with serious diabetes complications requiring strips and technology gets such nasty haraassement heaping extra emotional stress on a serious disease.

I for one am fed up with this crap and suspect all of us should take this into court and have restraining orders and harrassement suits. Why should one who is sick with serious diabetic comlications get another round of crap from liberty/noridian (CMS contractor) as a reward?

Can someone spell this out for me. The ADA just sits their like a deaf mute doing jack nothing over shinola!

If we look after ourselves, we save medicare/society thousands of dollars in long term costs. WHo is/are the green eye shades short sighted accountants running this nasty program?

WOW...YOU SAID IT BETTER THAN I COULD...

That is a good point, Jim. What does ADA do? JDRF? Do they have no active advocate role for diabetes care? Personally, and this is just me, I think there are too many MDs in those orgs, especially ADA and they are too buddy buddy with Congress. Again, my opinion. It can't all be about research; some should be about the current folks living with it and how to facilitate our self management.

I have a similar (although not quite the same) problem with getting my pump supplies from Medtronic. According to Medicare, you're not supposed to have more than a two-week supply on hand before they send you a new shipment...right, and what if a set (or two) is no good? I just had two reservoirs in a row that wouldn't deliver insulin and I had to throw them out.

I HATE the hassles I've been getting about pump supplies and test strips since I've been on Medicare. I understand they don't want to have us wasting supplies, or ordering extra to give to someone else, but two weeks back-up when it's such a serious issue?

Wish I knew who in congress/Medicare is responsible for setting these parameters so we could write and tell them what the REAL world of diabetes is like.

Ruth

I suspect a lot of the problem arises with medicare attempting to contain the fraud. And according to all, there is lot of that.

As for whom one writes to that is another fine kettle of fish. I have written the omsbudman of Medicare with no response or assistance over this.

As far as Congress, this probably ends up as a bun toss between the parties in House and Senate. The Democrats run the senate and the Republicans run the house and so far "never the twain shall meet!".

This truly is rhinocerous mud rutting time!

Medicare probably is on a no win situation with orders to cut costs.

My read depresses me greatly.

I don't have Medicare but regularly run into "issues" at the end of the year as it seems like the insurance-owned RX place is waiting to see how the insurance sets their parameters for the year. They generally also send a letter, citing the imbeciles at Medicare saying "you only need 4x strips/ day" before they mysteriously punt and give me the 14 my doctor writes, oh wait, they've mysteriously reduced that to 13/ day. It sucks to deal with insurance-induced stress during the darkest days of the year, when we should be enjoying the holidays like everyone else.

I get so frustrated with all the rules and requirements. This is life-sustaining stuff here,and we're made to jump through all sorts of ridiculous hoops. Regardless of whether you have Medicare or private insurance, the rules are insane at times. Caps on test strips, absurd requirements to visit physicians to get prescriptions, etc.....it's all so paternalistic and takes control away from the person who has to live with this condition. And Jims is right...the people using these things are using them so that they can stay healthy. Isn't that what the end goal is?

And testing only 4 times a day? Are you kidding me? I'd be dead if I only tested 4 times/day.

I AGREE WITH YOU...THE WHOLE THING STINKS...I GO TO SEE DOC WHEN I CAN & WHEN HE CAN SEE ME...EVERY 3 MONTH.

I am not yet using Medicare, but I ran into a huge problem with CCS medical when I was honest. I called to order, they asked a ton of questions, and then starting severely limiting what I was sent, to a point where I had no back up at all in case of emergency. "Your insurance will only cover this much, OR they won't allow it." I was lucky and got ahold of BCBS to find out if this was true, and it was not. BCBS contacted CCS and things got changed. I was lucky.

My theory is that CCS was having expired pump and CGM supplies returned to them and were trying to cut back how many they sent to avoid the losses. I was lucky that I went the extra steps, but many people will not, so the suppliers get away with some of this.

I have medicaid and I hate how theres so many rules involved with it..having to see endo in specific times..getting A1C every 3 months..only getting so many supplies...I mean I have no trouble complying with their rules..at the moment I'm pretty on top of things...but its so bad for the people that do struggle...Although I do hate it when people think "oh must be nice getting all your supplies and everything for basically free"..yeah it's pretty much free..but there is so much work involved with making sure you have the right paperwork the right tests, dr. visits...even saying the right things with out getting screwed over...it's not as easy as it looks sometimes! lol

I think one way to look at it is whether these quarterly visits are truly beneficial. The requirement results in Medicaid spending money for your doctor's visit. Are quarterly visits truly necessary? Would it more beneficial to provide coverage for a home or mail-in A1C tests (which are a lot cheaper than office visits and lab work)? If someone feels he/she needs guidance from an endo every three months, that's fine. But I don't know what the utility is of this being mandatory. Seems like wasted money IMHO. After so many years of living with T1, there just isn't much an endo can do for you. Seems to me that not making this mandatory would possibly save money. Thoughts?

My endo told me that I do not need quarterly visits. He said twice a year would be more than enough. But, he does not have the ability to do that due to Medicare. So I see the NP (CDE) every other time but that turns out to be just verifying all the orders, etc. They do try to help with diet, etc, but it is not something I can't do myself. I rarely have an acute issue. Today, with the endo, I had a real personal issue that is and will affect my diabetes management in the future but it scared him when he saw emotion so we quickly got back to the numbers!! He is actually a good endo--just not for personal issues.

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