More Information on the Medicare Competitive Bidding Program

After I posted the Medicare 2011 DME Changes, I found out a few more things that I wanted to share.

I know a lot of you are thinking that because you are not on Medicare, this stuff does not affect you.  Well, it does.  A lot of insurance companies follow Medicare guidelines so other insurance companies can start doing this same thing.  My friend Mary’s husband works for a very large corporation and his company switched insurance policies the first of the year.  Mary’s daughter has an intellectual disability and uses the Omni Pod pump and the Dexcom CGMS.  The Omni Pod is one of the easiest pumps to use and she is able to use it without having to make complicated decisions on what she should bolus.  Although Mary makes the important management decisions for her daughter, her daughter having a pump that she is able to use and give herself meal boluses with ease is something that is very important to both of them.  A CGMS is a very important part of her control and Mary does not have to worry 24/7 about her daughter having severe lows.  They were informed that their new insurance follows Medicare guidelines and they will not cover the Omni Pod or the Dexcom.  Now Mary has to start her year off fighting to try and keep the Omni Pod and Dexcom for her daughter.

[Read more…]

Medicare 2011 DME Changes

In case you are not aware, beginning January 1st, Medicare begins its Competitive Bidding Program. This program will take effect in 9 areas of the country and puts forth new rules about getting durable medical equipment, prosthetics, orthotics and certain supplies (which includes test strips). If you don’t live in one of the 9 areas but travel to one of those areas, you will need to follow the rules in order to get your supplies covered while you are away from home.

The areas included are North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida, Pennsylvania and California. Now I know that I listed 11 states and said 9 areas – that is government math for you! They have Cincinnati, Oh grouped with areas in Kentucky and Indiana so those three are considered one area, but the Cleveland area is listed as a separate group. It is not necessarily the whole state that will be affected. They have Pittsburgh listed but not Philadelphia. I live a couple hours from Pittsburgh and will not be in the changes for this year. The best thing to do is click on the link below if you are in one of the states I listed and enter your zip code to see if you are part of the 2011 change.

[Read more…]