Medicare refusal for CGMS

(Guy) #21

Hello Agate,

I am now in the process of replacing my Medtronic 670g with a Tandem T Slim X2 starting in the next week or 2 and it will be covered by Medicare and UHC Supplemental. I have also been told that after the first of the year, I will be able to order Dexcom 6 CGMs so that I can take advantage of the Basal IQ which integrates both the Dexom 6 with the Tandem T Slim. Based on videos I have viewed, the testimonials appear to suggest in general a great reduction in lows while asleep which is very, very exciting.

(agate) #22

Excellent! That combination sounds like the best system. Thanks for letting me know, and it will be fun to hear how you like it after a while. What’s also helpful for me to know is that you didn’t have to exhaust the 670G warranty before you’d have coverage for the Tandem T Slim.

Thanks so much!

Jim

(Guy) #23

Sure thing Jim. I will keep you posted. FYI - Until my 670g warranty is up, I will be renting to own the Tandem T Slim pum. What was your experience if any with the 670g Auto Mode. It just did not work well for me and was the reason why I chose the 670g before retiring. Guy

(agate) #24

That’s interesting, that you’ll rent to own the Tandem pump. Did Tandem come up with that approach, and is that how your Medicare Advantage will cover it?

My little brain says that since my Medicare Advantage carrier, HealthNet, does not cover the Medtronic sensors that works with the 670g pump, but it WILL cover the Dexcom sensors, that it would make the system “whole” by covering the Tandem pump. But I’ll just try to go along with the system.

Regarding Automode on the 670g, I have mixed feelings. I’ve been having quite a few sensor failures, when I insert a new one, go through the warm-up and initial calibrations, etc. But once it gets calibrated – after a day or two – then I get fairly accurate cgm readings, and the Automode works only okay. I end up having to give a lot of boluses, and tell it I’m taking 15-25 grams of carbs when I’m not, to get it to bring my glucose reading down to about 120. So I’m actually ready to give up on the Guardian 3’s, ask my diabetes clinic to prescribe a Dexcom G6 after the first of the year, and maybe then manually enter those readings into the 670g.

But what you’re doing may show me the way to get to the Dexcom G6 / Tandem T slim combination!

How’s that for a long-winded reply? J

Jim

(Guy) #25

Hi Jim,

Not long winded at all. Tandem was able hook me up to a medical supplier (Solara in Michigan) who set up this arrangement. In addition to Medicare I also use AARP/UHC for my supplemental. Medicare requires they rent the T Slim to me until my warranty has expired, which will not be until March 2021. In January I will need to pay $189.00 to cover my deductible and then I believe my costs will be low for the rest of the year. I am excited about the new feature of the T Slim with the Dexcom 6 Basal IQ technology which will automatically suspend my basal when my BS is trending low and will resume the basal once my BS is above 70. This is what I was hoping for with the 670g Auto Mode, but in this case I had too many highs and did not seem to be able to eliminate that for very long. I am also excited about the the Tandem platform which is like a cell phone and can receive updates. I also like the fact that the Dexcom 6 will require no Blood Glucose checks unless the numbers don’t appear correct. I have been using the Dexcom 5 for about 8 months and really like it. Easy to insert and one can extend the time using a CGM for 2 weeks with no problem. The cost of the Guardian 3 for my CGM would have been $300+/month which is a lot of money on a fixed income.

Unfortunately there is a back order for the T Slim pumps so I will not get it until the end of this week or next. I will keep you posted! Guy

(Michael) #26

I also use guardian sensors and on Medicare. My secondary insurance is Federal blue cross blue shield. I was getting sensors out of Florida ,nail they quit accepting out of network payment from fep. I paid cash from Medtronic and my blue cross-blue shield paid $3.00 on the over $1000 -15 sensor bill. I need to change to dextrin g6 I guess. Federal employee blue is a joke since every state reimbursement is different. They also will not tell you in advance. Disappointed that Medtronic does help with at least
Secondary insurance.

(David) #27

Since becoming eligible for Medicare 11 years ago, I have been covered thru Aetna in Colorado and BCBS in Florida for all my Medtronic pump and sensor needs. Prior to Medicare, my pump and supplies were covered by others for about 15 years.
Medtronic support is your best resource for coverage of their system.

(BeccaGae) #28

Agate,
The reasoning behind your Advantage plan not covering the Medtronic sensors for the 670g but they do cover the Dexcom is one simple answer.
Dexcom is a Medicare approved DME CGM
Medtronic is NOT a Medicare approved DME CGM.
Which means if you are on Medicare and want a CGM. You have the choice. You can continue with Medtronic and it’s Guardian system (stand alone or in conjunction with the 670g pump) and pay for it fully out of pocket, or you can go to Dexcom and Medicare will pick up everything but $53.11 per month (Medicare subscription copay). (It is a no brainer… my Enlites were $260 cash price when I used them… and I know the Guardian sensors are a lot more… and Dexcom is just over $50… over $200 savings per month… plus I now own a in warranty 630g pump but wear a OmniPod).