Denied a Dexcom while being on Medicare

[fisherman]

I use Afrezza.  

I am also on Medicare. 

Upon asking my Dr. to be able to apply for and receive a Dexcon unit he told me that I could not.  

The reason is that I did not inject insulin.  

So I called Jerome at Dexcom.  He said that my denial of a unit, even though I am on Medicare was indeed correct.  

Jerome at Dexcom did tell me that they are meeting about this very topic.  I believe this week and that he will call back should my Medicare status for a Dexom unit while  using Afrezza change.  

[peppy]

Feb 10, 2018 11:09:57 GMT -5 fisherman said:

I use Afrezza.  

I am also on Medicare. 

Upon asking my Dr. to be able to apply for and receive a Dexcon unit he told me that I could not.  

The reason is that I did not inject insulin.  

So I called Jerome at Dexcom.  He said that my denial of a unit, even though I am on Medicare was indeed correct.  

Jerome at Dexcom did tell me that they are meeting about this very topic.  I believe this week and that he will call back should my Medicare status for a Dexom unit while  using Afrezza change.  

Thank you for telling us fisherman.
In some strange way, it seems to be correct, injectable insulin.

Are you using basal? That doesn't qualify? Interesting caveat. thank you for telling us.
I might dig up the qualifying criteria and post.
Yikes. Dexcom is what initial Afrezza users need, to see and learn Afrezza. So observable. 

[peppy]

www.dexcom.com/medicare-coverage
Who is covered under Medicare?
According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met:

The beneficiary has diabetes mellitus; and,
The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,
The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
Within six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
In order to be included in this category, the system must be defined as therapeutic CGM, meaning you can make treatment decisions using the device.

Note: Under the current ruling, the beneficiary may NOT use their smart phone to display glucose data and still be eligible for reimbursement for the purchase of a therapeutic CGM: you cannot use the Dexcom CGM app to display glucose data and be eligible for reimbursement from Medicare.

[mnholdem]

That's a problem. Afrezza users seldom need adjustments in their treatment after their initial titration has determined the dosage needed for various types of meals. The rule just goes to show how that PWDs who use RAA insulin for mealtimes are frequently out of control. 

"Before & After Afrezza" CGM graphs shared by Afrezza users over the past few years have demonstrated this many times.

[fisherman]

I take two 500mg tables of Meformin.   One in the morning and one at night.  My a1c has been excellent too. 

I do not need to take any injections now due to Afrezza.  

I vary my Afrezza between 4 and 8 unit and at rare time one each (12 total units) to very effectively to stay in range.  

But I could do a much better job if I had a Dexcom, obviously.   But I don't qualify due to not needing to make any injections.   

[peppy]

Feb 10, 2018 15:07:21 GMT -5 fisherman said:

I take two 500mg tables of Meformin.   One in the morning and one at night.  My a1c has been excellent too. 

I do not need to take any injections now due to Afrezza.  

I vary my Afrezza between 4 and 8 unit and at rare time one each (12 total units) to very effectively to stay in range.  

But I could do a much better job if I had a Dexcom, obviously.   But I don't qualify due to not needing to make any injections.   

This is the important news now, "Jerome at Dexcom did tell me that they are meeting about this very topic. I believe this week and that he will call back should my Medicare status for a Dexom unit while using Afrezza change. "

I am sure afrezza qualifies for the change. Let us know please. 

quote; The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,

it could be changed to 3 or more daily subq, IM or alveolar injection, 
or it could be changed to 3 or more doses of rapid acting mealtime insulin daily.
or ?

Thanks, and do let us know.

[sayhey24]

Feb 10, 2018 11:09:57 GMT -5 fisherman said:

I use Afrezza.  

I am also on Medicare. 

Upon asking my Dr. to be able to apply for and receive a Dexcon unit he told me that I could not.  

The reason is that I did not inject insulin.  

So I called Jerome at Dexcom.  He said that my denial of a unit, even though I am on Medicare was indeed correct.  

Jerome at Dexcom did tell me that they are meeting about this very topic.  I believe this week and that he will call back should my Medicare status for a Dexom unit while  using Afrezza change.  

fishman - as a T2 why not get the Lbre?  The sensors run about $45 and with the Glimp you can get the 14 days with them.   Not being a basil user you should have little chance of a severe hypo.  Even without insurance its only going to run you a little more than $20 a week.

With the Glimp you calibrate it one time and thats it, no daily calibration needed. 

[agedhippie]

Feb 10, 2018 15:07:21 GMT -5 fisherman said:

I take two 500mg tables of Meformin.   One in the morning and one at night.  My a1c has been excellent too. 

I do not need to take any injections now due to Afrezza.  

I vary my Afrezza between 4 and 8 unit and at rare time one each (12 total units) to very effectively to stay in range.  

But I could do a much better job if I had a Dexcom, obviously.   But I don't qualify due to not needing to make any injections.   

If you are not taking a basal insulin you may well fail the MDI test even if they accept Afrezza as equivalent to RAA (which I would expect they will). Basal insulin is a component of the MDI protocol.

[fisherman]

Sayhey,   

My favorite person is Will Rogers.  He said, "Every man is ignorant is different topics."   

I had not heard of your suggestion and it would appear to be a capital idea.  

Thank you very much.

PS:   If you are a baseball nut like me go to the Negro National Baseball Museum in Kansas City, Mo.  www.nlbm.com/
You will discover new things about baseball.  Jackie R. was great but not the first negro pro.  The KC Monarchs were the first pro team to play under their own portable lights.   And a ton of other great stuff.  And after the museum you can go down to the Blue Room and listen to some great great live Kansas City jazz.   

Just thought that I would return a tip for you.  

[sayhey24]

Yes, IMO Willie was the greatest player of all time. However I was a huge Yankee fan growing up. I may just do as you suggest when MNKD hits $200 which should not be too long now or so many of us hope.

With the Libre, the U.S. reader has been hacked to only allow the 10 days and the new EU readers won't work with the U.S. sensors. The old readers will and are available on Ebay. However, just start the sensor with the US reader and after an hour our so calibrate it to the glimp which should give you better numbers than you will get on the Dexcom. This should get you the 14 days too.

[fisherman]

SayHey;

One more baseball fact. Have you ever here of Moe Berg. I consider his the bravest, most patriotic ball player in US History. I share this one as often as possible. And to keep the administrator off me, I can have a pizza and a beer at the park freely with Afrezza.

Look at these. Did you know about Moe Berg? He is my hero in pro baseball: www.youtube.com/watch?v=jBUFpdGMej4
www.youtube.com/watch?v=yFmJ4B4SLTo

Dr. Al Mann. as a Jewish man. would be darn proud of this fellow Jewish Baseball player that hit the Axis bastards one lick after another!

[mytakeonit]

Since the thread is already messed up ...

What are the last two words of the National Anthem?

Answer: Play Ball !!!

[sayhey24]

Feb 11, 2018 15:18:36 GMT -5 fisherman said:

SayHey;

One more baseball fact. Have you ever here of Moe Berg. I consider his the bravest, most patriotic ball player in US History. I share this one as often as possible. And to keep the administrator off me, I can have a pizza and a beer at the park freely with Afrezza.

Look at these. Did you know about Moe Berg? He is my hero in pro baseball: www.youtube.com/watch?v=jBUFpdGMej4
www.youtube.com/watch?v=yFmJ4B4SLTo

Dr. Al Mann. as a Jewish man. would be darn proud of this fellow Jewish Baseball player that hit the Axis bastards one lick after another!

Its always interesting to learn new things - thanks.  I never heard of him but then again neither did anyone else since he was a secret agent
Funny thing is his dad never went to any of his games and neither did mine.  He always told me it was a waste of time and had me working with him on his "projects" in the basement.  He would drive me to the game and give me a dime to call him when it was over. 

BTW - Al Mann was not a doctor.  He got a few honorees but never an MD nor piled hip deep.  I think he was too busy changing mankind.  It would not surprise me if Al knew Moe Berg.

Good luck putting your AGP together.  Track your meals and after a month or so you will probably not need the Libre atleast not all the time.  You may want to try dropping the daytime metformin as it will effect liver function and any quick response needed for a low.    If you are waking up high keeping the before bed dose would be OK but better if you can get rid of that too.  A good walk will provide the same insulin sensitivity the metformin will.

[joeypotsandpans]

Feb 10, 2018 15:07:21 GMT -5 fisherman said:

I take two 500mg tables of Meformin.   One in the morning and one at night.  My a1c has been excellent too. 

I do not need to take any injections now due to Afrezza.  

I vary my Afrezza between 4 and 8 unit and at rare time one each (12 total units) to very effectively to stay in range.  

But I could do a much better job if I had a Dexcom, obviously.   But I don't qualify due to not needing to make any injections.   

I use the Libre and based on what you said it should work very well for you in lieu of using the Dexcom and is much less expensive. Call Abbott's number designated for those interested in the Freestyle Libre and they should be able to coordinate with your primary care provider...not sure how they work with Medicare so you may have to go out of pocket but once you get the reader then it's just a matter of getting the replaceable sensors each month. GL!

[vanc]

Feb 10, 2018 11:09:57 GMT -5 fisherman said:

I use Afrezza.  
I am also on Medicare. 
Upon asking my Dr. to be able to apply for and receive a Dexcon unit he told me that I could not.  
The reason is that I did not inject insulin. 

Has anyone heard whether there has been any movement on this, or other workarounds?  I'm in the same situation... Afrezza, Dexcom, and no Medicare coverage.