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.
Replies to This Discussion
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Permalink Reply by Nell on -
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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Permalink Reply by Shayla on
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Right now for me I do need to see the endo about every 6 weeks or so..but I'm hoping once my settings on my pump are straightened out I won't have to see him as much...I do agree that mail-in A1c tests would be better if they are cheaper :) Also I'm not sure if I have to see him every 3 months or 6? As long as I am seeing him thats all they want I guess...which I can understand..I don't think it's right for the government to give out money to people who are just going to waste supplies and whatnot if they aren't going to make an effort to take care of themselves ya know? :)
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Permalink Reply by barbraann on -
I had the name of the guy who wrote the codes for Medicare at one time but I've since lost it. I'm not yet on Medicare but I am not looking forward to it. I see my endo every 4 months and that works just fine, if they truly want to cut costs then we should see them when deemed neccessary! Are they afraid we're going to be miraculously cured between visits!!?? Our insurance is already following medicare guidlines and I now have to turn in a written log every 3 months which I've NEVER had to do before.
IT'S RIDICULOUS!!!!!
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