My Medical Supply Company is asking for tests!

Long story short... We got a pump a few months back, but had to replace it with a new pump.
We are now doing the paperwork to get the new pump.
The Medical Supply Company called me on Friday.
They are working on getting the new pump.

They are now requesting
1... A c-peptide test
2....A fasting blood gluclose test.... how do we manage that?
3....Last A1C

And yes, this the the MSC company requesting this from my daughter's endo!

 

The c-peptide test is for them to make sure she has Type 1. She does have Type 1; she will have a low to no c peptide. Don't know why they want a fasting glucose test. I would see if she can get out of that one. A1c, don't know if they want to deny you if its too good. Have endo explain the lows she's having which will drag down an A1c. Stress the lows, hypoglycemic awareness as reasons for cgms and that she needs tiny increments of insulin hard to give with syringe, easily given by pump.

 

Don't bolus for dinner and record the wake up number. I'm sure I could easily get a "HI" for one night in order to get a pump. A hoop I'd gladly jump through.

A type 2 with some insulin production would have a much better fasting number.

 

why are you doing paper work to replace a broken pump?

 

Well , this is what either the pump company needs or Your insurance needs.

You have given them permission to work at getting the pump for you, correct.

I know that we have to go thru a distributor to get our Dexcom and needed to get them the presription and letters from the endo.

If you are at all warry, them don't give them the information. Your endo should know what your insurance criterian is, or call then yourself. Your endo has to be on board since they have to write a lab orders for you,?

 

Scott.
Is it better to have a higher or lower blood sugar to get approval for the pump?
Also, we have to go get he blood from LabCorp, it can't be done on the meter!

 

I did question these tests and why the MSC is doing this.
Supposedly these tests are a new requirement.
They are working closely with the endo and Animas.
When I talked to the Animas rep, she new exactly who I was dealing with.

 

Not a broken pump.
Totally different pump.
Returned the first one, getting a totally different one

 

Oh, is that all? I was thinking of glucose tolerance test. That one is easy.

 

Wow ..we go to the same dr..I didnt have to do all this for the pump..unless the dr office did it for me and Im not aware of it...???
Im so sorry this has been such an experience for you and L...
If I can help, let me know..you have my number Im only a few minutes away!!!

 

Thanks Ro!
The first pump was nothing! Dr. B's office did everything.
For some reason, things changed since the beginning of the year and they need these new tests.
I talked to "L" this morning, and she is really helping move this along!

 

Ahh, ok.. I know others have had to go through this.. hopefully it can be done quickly.

 

These are the requirements Medicare uses for a new pump. Just an FYI the blood sugar fasting with the C-peptide needs to be under a certain number 210. Actually when they did this test on me somehow the fasting wasn't ordered they thought I would have to repeat both tests but they got it through somehow. I have no clue.
Wendy

 

Is Medicaid paying for part of the claim? I believe this is a new Medicaid requirement, but I could be wrong.

 

Hi BrensDad
No, this is just regular health insurance.

 

Thanks.
I can't imagine her being anywhere near 200 with a fast by the time I get her to LaBCorp, they do the test, etc.
But... if she's sick for some reason, and running high, I should cancel, because they wont approve a pump if the number is over 200? Crazy!

 

If it helps Medicare requires these tests and I think a lot of insurance companies and other medical supply companies are now requiring them as well. Ask them what they are specifically looking for and at the same time remind them that you are replacing a broken pump.

 

Just went through all of this with Chell and medicare. So to answer your questions, its an insurance thing. Medicare and many State Medicaid insurances are now asking for this. This is also to prove you have type 1 not type 2.

C-peptide test is to determine how much insulin the pancreas is making. The fasting glucose test goes with the c-pepetide test. The last A1c is just a guide.

The lower the fasting number is the better. If a fasting number is above 230 most labs will not or should not do the test! If your child wakes up a bit on the high side...dont worry..give insulin to correct the high. The c-peptide level is based upon the last 15-20 minutes of the pancreas.

 

Our insurance has adopted medicaid guidelines. We have to send in a months worth of BS readings to the supply company in order to get an override on the medicaid allowance of 100 strips per month. A letter of necessity from the Doctor will not work. When I talked to our CDE, she said a lot of insurance companies are changing their policies and going with the medicaid guidelines.

 

My guess is that it's the insurance asking these questions and the supply company is acting as a liaison. Those are the exact tests Medicaid/Medicare require to approve a pump, and many private insurances use those as a guideline as well. By the way, the criteria for approval requires a fasting bg BELOW a certain number, not a high one, so don't go skipping insulin.