I have been Type 2 for 15 years and using MDI. I have attempted to get a pump via Medicare Advantage. Tandem requires that I have a c-peptide of 5.5 or lower and a fasting < 250. My c-peptide is 6.2 and until now I never went over 210 after meals. Do you have any ideas on how to get a pump?
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I’m surprised Tandem requires c-peptide to get. Unless they assume having pump insulin plus pancreas insulin would not work well, not tested, or knowing it is small customer need.
Or may be Tandem relaying requirements for c-peptide from insurance coverage, which is common.
Medicare definitely requires testing. Employer plans may vary.
I got first pump in late 80s, was dx at age 5. And I still had to have c-peptide tests when switching insurance. And this year will switch to MC, and may need to have it checked again.
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I don’t think it’s Tandem but Medicare. Medicare has harsh rules on pumps, especially for type 2.
I am away from home or I would quote the exact requirements for pump coverage.
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I was just relaying what original post implied that Tandem was requiring it.
Agree that the payer/insurance usually makes the requirements for approving/denials.
Most use the C-peptide test.
My first pump was in mid 80s, and had to get current c-peptide each time my insurance changed, and likely need to prove to Medicare one more time.
I make no insulin!!!
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I don’t believe Medicare will cover an insulin pump for a type 2. Rules change, I suggest you call your insurance company and ask them what the criteria for coverage is.
Per Medicare
“When considering both cost-effectiveness and risk-benefit, there are no compelling reasons to widely use insulin pumps in patients with type 2 diabetes at this time.” Advantage plans are not likely to cover something regular Medicare doesn’t.
NCA - Insulin Infusion Pump (CAG-00041N) - Decision Memo.
Here is a lengthy article about pumps.
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I am on an Advantage plan as a retirement benefit, and my pump and supplies as covered even though I am type 2.
I don’t ask why because I don’t think I qualify.
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That’s wonderful @CarlosLuis. It does say no compelling reasons to widely use for type 2’s, that seems like there might be some wiggle room? But don’t rock the boat!!!
But rules change as Medicare is now covering some CGM’s for some type 2’s now. And then we know all the different insurance companies have their own rules. And sometimes some things just slip through the cracks, and sometimes it’s how the doctor writes the request and possible appeals.
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