The rule that Medicare Advantage is following is a Medicare rule. I'm not defending Medicare Advantage. That was my husband's, a retired accountant's idea, although I was skeptical after hearing what you said on your show. If we return to Medicare, the rule will still apply, and the co-pay will probably be higher now. I'm doing medical research to support that Medicare's rule is unreasonable and dangerous. Could you please research the MACs, how they get their contracts, and the part politics plays? The voters need to understand how it works.
Gloria — There’s lots of evidence here that Medicare does pay for the monitors — but your caveat, that one must JUSTIFY the use of a monitor, remains to be clarified. It does sound like something of a Catch 22, if it is nationwide, and not a caveat only where you are.
Frustrating, but definitely something to know more about — for people who DO have insulin issues and Diabetes Type 2 issues, this is no small thing.
I do want to know if this is hit-or-miss or a system problem.
I have it in writing that this is Medicare's rule that the advantage plan is following. I don't know if the administrative law judge only applies the fact to the rule or has room to say it's unreasonable.
I don’t know how such a “rule” gets changed or modified to work better, but it needs changing .. It’s not like any old person can just demand a monitor on a whim, but someone dealing with Type 2 and clearly managing it with their doc needs to have tools and resources to handle STAYING healthy, not just responding to declining status.
Sorry it’s sucky, Gloria. I guess we need better people in charge — Hoping we get them.
If you return to Medicare, during Open Enrollment which I believe is on right now, Medicare rules will apply. You will not be stuck with the private insurers rules.
Medicare suscriptions are filled either via a local pharmacy, and each pharmacy or chain, has it's own contracts or through Express Scripts, which has it's own contracts.
For instance I started blood glucose monitoring using Rite Aid, which had a contract with Free Style and never paid for my monitor or strips, but I moved and there is only one pharmacy and it is local, not part of a chain, and does not have a contract, so they use the cheapest Medicare approved provider, and that is Metric, even Express Scripts has their own contract.
Who is your Medicare Advantage company?United Health Care?
Unlike Medicare, Medicare Advantage programs deny reimbursement for procedures they don't approve.
As you know Medicare covers 80% and I have never had to pay a co pay. The 20% can be covered by Medigap, either private or group,
AARP has a Medigap plan.
I'm fortunate in that I have Tricare. I did have a secondary through CalPers but they upped their premium for my Plan (out of state) by 30.74% so I quit.
Wow. You do know, don't you, that all of the rules of Medicare are in their because of lobbying by AHIP. It is also the reason that we don't have Bernie's single payor, but instead a 600 page ACA.
AHIP, the Association of Health Insurance Providers, have a lot of clout in D.C., it is called campaign contributions, dark money, and twice as many lobbyists as there are Congress critters. Find me a congress critter that has the backbone to tell AHIP to get eff'ed.
My opinion as to why we don't have single payor (a one sentence change to 42 U.S.C. § 1395 et seq, subchapter XVIII, is Nancy Pelosi and Rahm Emanuel.
Gloria I missed you for a couple days, I too have to deal with pre-diabetes. What I found works the best for me is to exercise twice a day and bring my heart rate up at least a third for one half hour each session. I recommend the teeter free stepper, It is low impact. I will start taking metformin thanks to Thoms advice. Pot can lower your blood sugar a lot. So be careful about hypoglycemia and the munchies. My blood sugar actually went down to 39 in the seventies while experimenting with my mother's blood glucose monitor. Pot brownies! Now it likes to hang around 130 🤬. I hope this helps you a little anyway.
Correct Thom. See my response to Gloria. I am on Medicare and have no problem at all,other than my local pharmacy does not have a contract with Free Style and have to use Metric,.
I'm not talking about glucometers and finger sticks. This is an arm patch with a sensor that measures blood glucose in real time and sends the info to the phone every 5 minutes 24/7.
AND anyone actively managing Type 2 or Pre-diabetes should have access to this kind of monitoring to establish a baseline and/or catch a situation in the process of building … Limiting access is JUST WRONG. And, sure, lobbying by the folks who have to pay for health services — since they collect payments to enroll in the insurance programs — is probably the crux of the issue … They want to collect the premiums and NOT pay for care.
We need BETTER people setting policies and making rules.
{Bernie would have been better — but this pre-dates Bernie. When Obamacare was originated, the R’s insisted on keeping insurance companies at the heart of it, convincing us that we needed them, and they put these obstacles in place, and then the R’s wouldn’t vote for the system ANYWAY. We got the system we got, an improvement over the way it worked before, but seriously flawed, still …
We need BETTER people making the rules, and better people in the Senate and Congress.
Sounds like you have Medicare Advantage rather than real Medicare?
The rule that Medicare Advantage is following is a Medicare rule. I'm not defending Medicare Advantage. That was my husband's, a retired accountant's idea, although I was skeptical after hearing what you said on your show. If we return to Medicare, the rule will still apply, and the co-pay will probably be higher now. I'm doing medical research to support that Medicare's rule is unreasonable and dangerous. Could you please research the MACs, how they get their contracts, and the part politics plays? The voters need to understand how it works.
Gloria — There’s lots of evidence here that Medicare does pay for the monitors — but your caveat, that one must JUSTIFY the use of a monitor, remains to be clarified. It does sound like something of a Catch 22, if it is nationwide, and not a caveat only where you are.
Frustrating, but definitely something to know more about — for people who DO have insulin issues and Diabetes Type 2 issues, this is no small thing.
I do want to know if this is hit-or-miss or a system problem.
Good thoughts to you, Gloria
I have it in writing that this is Medicare's rule that the advantage plan is following. I don't know if the administrative law judge only applies the fact to the rule or has room to say it's unreasonable.
I don’t know how such a “rule” gets changed or modified to work better, but it needs changing .. It’s not like any old person can just demand a monitor on a whim, but someone dealing with Type 2 and clearly managing it with their doc needs to have tools and resources to handle STAYING healthy, not just responding to declining status.
Sorry it’s sucky, Gloria. I guess we need better people in charge — Hoping we get them.
If you return to Medicare, during Open Enrollment which I believe is on right now, Medicare rules will apply. You will not be stuck with the private insurers rules.
Medicare suscriptions are filled either via a local pharmacy, and each pharmacy or chain, has it's own contracts or through Express Scripts, which has it's own contracts.
For instance I started blood glucose monitoring using Rite Aid, which had a contract with Free Style and never paid for my monitor or strips, but I moved and there is only one pharmacy and it is local, not part of a chain, and does not have a contract, so they use the cheapest Medicare approved provider, and that is Metric, even Express Scripts has their own contract.
Who is your Medicare Advantage company?United Health Care?
Unlike Medicare, Medicare Advantage programs deny reimbursement for procedures they don't approve.
As you know Medicare covers 80% and I have never had to pay a co pay. The 20% can be covered by Medigap, either private or group,
AARP has a Medigap plan.
I'm fortunate in that I have Tricare. I did have a secondary through CalPers but they upped their premium for my Plan (out of state) by 30.74% so I quit.
It is MEDICARE's rule.
Do you mean that when you rejoin Medicare from MA you will suffer under the same rules as your MA plan?
Yes for this rule.
Wow. You do know, don't you, that all of the rules of Medicare are in their because of lobbying by AHIP. It is also the reason that we don't have Bernie's single payor, but instead a 600 page ACA.
AHIP, the Association of Health Insurance Providers, have a lot of clout in D.C., it is called campaign contributions, dark money, and twice as many lobbyists as there are Congress critters. Find me a congress critter that has the backbone to tell AHIP to get eff'ed.
My opinion as to why we don't have single payor (a one sentence change to 42 U.S.C. § 1395 et seq, subchapter XVIII, is Nancy Pelosi and Rahm Emanuel.
Thanks for the info. What's that website with the donors? I forget.
opensecrets.org
Gloria I missed you for a couple days, I too have to deal with pre-diabetes. What I found works the best for me is to exercise twice a day and bring my heart rate up at least a third for one half hour each session. I recommend the teeter free stepper, It is low impact. I will start taking metformin thanks to Thoms advice. Pot can lower your blood sugar a lot. So be careful about hypoglycemia and the munchies. My blood sugar actually went down to 39 in the seventies while experimenting with my mother's blood glucose monitor. Pot brownies! Now it likes to hang around 130 🤬. I hope this helps you a little anyway.
Correct Thom. See my response to Gloria. I am on Medicare and have no problem at all,other than my local pharmacy does not have a contract with Free Style and have to use Metric,.
I'm not talking about glucometers and finger sticks. This is an arm patch with a sensor that measures blood glucose in real time and sends the info to the phone every 5 minutes 24/7.
AND anyone actively managing Type 2 or Pre-diabetes should have access to this kind of monitoring to establish a baseline and/or catch a situation in the process of building … Limiting access is JUST WRONG. And, sure, lobbying by the folks who have to pay for health services — since they collect payments to enroll in the insurance programs — is probably the crux of the issue … They want to collect the premiums and NOT pay for care.
We need BETTER people setting policies and making rules.
{Bernie would have been better — but this pre-dates Bernie. When Obamacare was originated, the R’s insisted on keeping insurance companies at the heart of it, convincing us that we needed them, and they put these obstacles in place, and then the R’s wouldn’t vote for the system ANYWAY. We got the system we got, an improvement over the way it worked before, but seriously flawed, still …
We need BETTER people making the rules, and better people in the Senate and Congress.
Gee, I wonder how we make that happen.