I heard back from both Tandem (Tslim Pump) and Animas (Ping Pump), and they are requiring a c-peptide and fasting blood glucose. I do have a meeting with the Animas rep on Friday, for the demo.

I am feeling a bit discouraged, I am a type 2 (as far as I know) and heard that many times (especially with Medicare replacement policies) T2's are not covered for the pump.

I am angry that insurance companies can have so much control over something that a doctor deems a good idea.

The one thing, thus far, going for me is that I am on the vGo. The vGo is like a disposable insulin pump that you change every 24 hours, but you only get 60 units pre-filled in it (and take 'clicks' depending on what you eat.)
It is limiting, which is why my doctor felt an actual pump was a good idea.

Fingers crossed!

Views: 93

Tags: animas, insulin, medicare, pump, tslim

Comment by Brian (bsc) on July 30, 2014 at 5:32am

Unfortunately Medicare has a distinct bias against T2s initiating pump therapy. The criteria from Medicare are:

Criterion A: The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin doses for at least 6 months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least 4 times per day during the 2 months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen:

  • Glycosylated hemoglobin level (HbAlc) > 7.0%;
  • History of recurring hypoglycemia;
  • Wide fluctuations in blood glucose before mealtime;
  • Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl; or,
  • History of severe glycemic excursions.

So basically you have to demonstrate that you have achieved poor control.  For most people getting a pump before entering Medicare is the only sane option. I'm not saying Medicare won't cover a pump, just that it will likely require a letter of medical necessity and a hassle.

Comment by jesikabeth on July 30, 2014 at 6:56am

Thank you so much for all your help, again :)

My A1C is at a 6.9 right now. I have hypoglycemia every so often. Definitely have Dawn Phenomenon and wide fluctuations in blood glucose before mealtime. Does Medicare require a log? Otherwise how would they know/tell?

PS What's a glycemic excursion?

Comment by Brian (bsc) on July 30, 2014 at 7:55am

So many questions. I believe your doctor will document things, he may ask for a log. A glycemic excursion is a wide swing in blood sugars. Often this is caused by overcorrecting.

Comment by SEAGATOR on July 30, 2014 at 5:00pm

When I got out of Rehab broken hip. I needed a wheelchair and a walker. Medicare said you can have one but not both. Idiots I needed the WC to get around and the walker to help me learn how to walk again. I took the WC for 135 days. Went to a very nice thrift shop and got a new walker for $12. H ope all is well with you. At age 87 I would never trt to walk without a walker. Reed

Comment by jesikabeth on August 4, 2014 at 7:47am

Hey all. I go to my diabetes doc on Friday a.m. for a c-peptide test and fasting BG. Met with the Animas rep, and love the Ping. Moving along... just wanted to update :)

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