August 22, 2004
Insurance/Costs
Question from Breaux Bridge, Louisiana, USA:
My question is about Medicare and it’s guidelines concerning insulin pumps and pump supplies. I have found out quite a bit, but am still concerned about one thing: qualifying for a pump and pump supplies under the Medicare guidelines.
The rules state that you must qualify under either Part A or Part B of the guidelines, not both. However, I qualify for everything under Part A, but I am being denied because of Part B guidelines. Part B discusses a C-peptide exam that must be no more than 110% of the laboratory’s minimum requirements. Different labs use different methods. Also, the A1c should be greater than 7. The reason to control these numbers is to inject insulin. Fasting for four to eight hours does not work. If I were to go off insulin for any longer, I would be in trouble as I have very brittle diabetes. It is not unusual that my sugars can drop into the mid 30s mg/dl [1.8 to 2.1 mmol/L] during the night and then go upwards of 500 mg/dl [27.8 mmol/L] with no apparent reason. Could anyone shed any light on this subject of C-Peptide as relates to Medicare?
Answer:
They are making sure you have a form of diabetes where you don’t make insulin. In other words, they have a policy that will pay for patients with type 1 diabetes, but not patients with type 2 diabetes. For most people, that means a C-peptide less than 0.8. You are correct in stating different laboratories have slightly different lower levels of normal range and also detection. Just ask your physician what your local laboratory uses and it should be clear.
JTL
