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Thread: New Medtronic pump approved

  1. #51

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    I simply can't understand how this would be sustainable for them. There are plenty of people who want to pump but who don't want to CGM or don't have insurance coverage for CGM. So you're telling me they are REALLY going to deny a pump to someone? They're really going to tell the consumer "sorry, out of luck."

    I really don't believe it.
    son, age 14; dx 2005 @ age 5
    Pumps: Cozmo 2006; Revel 2010
    CGMS: MM 2010; Dexcom G4 2013

  2. #52

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    Quote Originally Posted by Mish View Post
    I simply can't understand how this would be sustainable for them. There are plenty of people who want to pump but who don't want to CGM or don't have insurance coverage for CGM. So you're telling me they are REALLY going to deny a pump to someone? They're really going to tell the consumer "sorry, out of luck."

    I really don't believe it.
    I suspect if someone can't get insurance coverage for the CGM, they'll sell them a pump without it. But this is a way to get people to try to get coverage for it who really aren't interested in it.
    Mom to J., age 10
    Dx 2007 @ age 3
    Medtronic pump and CGM (4/2008-6/2013)
    Tandem t:slim and Dexcom G4 CGM (current)
    CGM in the Cloud 7/2014

  3. #53

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    I think Medtronic is on the extreme defensive side when it comes to covering themselves with FDA issues.

    Also, if Medtronic is going to "force" you to get the CGMS bundled with the pump, I would call your insurance company and have them tell Medtronic to tell Medtronic "no" because their CGM is not medically necessary, especially when you have a CGM (i.e. Dexcom) that already works. I mean, the insurance company does not like paying for claims anyways, so the insurance company would be interested and would advocate on your behalf.

    Also, I don't understand how they could "bundle" an item that is not necessary, especially if you are having success with a Dexcom CGM, if determined so by a MEDICAL DOCTOR. I would think the FDA would be all over them for that.

    Medtronic may be committing fraud (I do not know the laws, though). This is certainly unethical of them, especially when a MEDICAL DOCTOR recommends therapies and prescribes NEEDED devices. The doctor and the insurance company should get the final say, in this circumstance, after a treatment approach has been agreed upon. You can always try reporting this as "fraud" to your insurance company or state's attorney general, via an online form. After all, it would be fraud to force somebody to pay for Medtronic's CGM if the insurance company did not cover it anyways. However, this really could be consumer or insurance fraud (or both), since both the consumer and the insurance company are paying, but I am no lawyer.

    Wikipedia Definition of Insurance Fraud:

    Insurance fraud occurs when any act is committed with the intent to fraudulently obtain some benefit or advantage to which they are not otherwise entitled or someone knowingly denies some benefit that is due and to which someone is entitled.

    Wikipedia Definition of Medical Necessity ("Medically Necessary"):

    Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.

    (Probably determined by MEDICAL DOCTORS and ultimately insurance companies, NOT medical device manufacturers.)
    Last edited by moco89; 10-04-2013 at 06:58 PM.
    Young adult with type 1 diabetes, autoimmune autonomic neuropathy, and chronic inflammatory demyelinating polyneuropathy (CIDP)

  4. #54

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    This could be health consumer fraud, if they force you to get the CGM.

    http://www.medicare.gov/Publications...merFraud_5.asp

    Unscrupulous Supplies May:

    * Provide more expensive equipment than medically necessary (sometimes a problem with motorized and non-motorized wheelchairs and manual and electric beds),

    I (think) you can report it here. http://www.accessdata.fda.gov/script...ci/contact.cfm, or via your state's attorney general's office.
    Young adult with type 1 diabetes, autoimmune autonomic neuropathy, and chronic inflammatory demyelinating polyneuropathy (CIDP)

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