Medicare & CFRD

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AimeeSue82

New member
I just tried to get lancets and test strips filled at my pharmacy. They said Medicare denied my claim because "CFRD isn't really a diabetes diagnosis". They're saying CFRD isn't really diabetes so they won't cover my supplies!! I was just dx in June, but in July this same pharmacy filled scripts for all of my supplies and insulin. The pharmacist today said that claim was denied too but they'd already given me the stuff. She was saying Medicare wasn't paying them for any of it so they were out that money.  Now I have two questions:<br><br>1. Has any one else been denied this stuff b/c of this dumb excuse?  If so, how do I get around it? <br><br>2. Does Walgreens have any grounds to bill me for last months supplies that Medicare denied? If I have to fight my own battle with Medicare, I don't want to have to fight Walgreens' battle also!<br><br>PLEASE HELP!!<br><br>~Aimee, 28 CF, MRSA, CFRD<br>
 
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AimeeSue82

New member
I just tried to get lancets and test strips filled at my pharmacy. They said Medicare denied my claim because "CFRD isn't really a diabetes diagnosis". They're saying CFRD isn't really diabetes so they won't cover my supplies!! I was just dx in June, but in July this same pharmacy filled scripts for all of my supplies and insulin. The pharmacist today said that claim was denied too but they'd already given me the stuff. She was saying Medicare wasn't paying them for any of it so they were out that money. Now I have two questions:<br><br>1. Has any one else been denied this stuff b/c of this dumb excuse? If so, how do I get around it? <br><br>2. Does Walgreens have any grounds to bill me for last months supplies that Medicare denied? If I have to fight my own battle with Medicare, I don't want to have to fight Walgreens' battle also!<br><br>PLEASE HELP!!<br><br>~Aimee, 28 CF, MRSA, CFRD<br>
 
A

AimeeSue82

New member
I just tried to get lancets and test strips filled at my pharmacy. They said Medicare denied my claim because "CFRD isn't really a diabetes diagnosis". They're saying CFRD isn't really diabetes so they won't cover my supplies!! I was just dx in June, but in July this same pharmacy filled scripts for all of my supplies and insulin. The pharmacist today said that claim was denied too but they'd already given me the stuff. She was saying Medicare wasn't paying them for any of it so they were out that money. Now I have two questions:<br><br>1. Has any one else been denied this stuff b/c of this dumb excuse? If so, how do I get around it? <br><br>2. Does Walgreens have any grounds to bill me for last months supplies that Medicare denied? If I have to fight my own battle with Medicare, I don't want to have to fight Walgreens' battle also!<br><br>PLEASE HELP!!<br><br>~Aimee, 28 CF, MRSA, CFRD<br>
 
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julie

New member
Aimee, do you have anything about the denial in writing? If not can you get it and email it or fax it to me? services@dafcf.org or 360-200-4516? Block off all your identifying info for the time being since I don't have a confidentiality agreement on you yet. I haven't delt with this type of denial, but I'd be happy to help you with it.
 
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julie

New member
Aimee, do you have anything about the denial in writing? If not can you get it and email it or fax it to me? services@dafcf.org or 360-200-4516? Block off all your identifying info for the time being since I don't have a confidentiality agreement on you yet. I haven't delt with this type of denial, but I'd be happy to help you with it.
 
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julie

New member
Aimee, do you have anything about the denial in writing? If not can you get it and email it or fax it to me? services@dafcf.org or 360-200-4516? Block off all your identifying info for the time being since I don't have a confidentiality agreement on you yet. I haven't delt with this type of denial, but I'd be happy to help you with it.
<br />
 
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JennifersHope

New member
I have been denied for a lot of prescriptions on Medicaid, I would call your nurse at your clinic and let them know, I think it is standard for them to deny just about everything these days I swear, The nurses are very well equipped to write letters of medical necessity to the insurance company. That is what they have done for me, it takes a bit but it works....

Your nurse or doctor can change the diagnoses code also, it is just red tape, it stinks but it can be worked through. The nurses have been great about doing it for me.
 
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JennifersHope

New member
I have been denied for a lot of prescriptions on Medicaid, I would call your nurse at your clinic and let them know, I think it is standard for them to deny just about everything these days I swear, The nurses are very well equipped to write letters of medical necessity to the insurance company. That is what they have done for me, it takes a bit but it works....

Your nurse or doctor can change the diagnoses code also, it is just red tape, it stinks but it can be worked through. The nurses have been great about doing it for me.
 
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JennifersHope

New member
I have been denied for a lot of prescriptions on Medicaid, I would call your nurse at your clinic and let them know, I think it is standard for them to deny just about everything these days I swear, The nurses are very well equipped to write letters of medical necessity to the insurance company. That is what they have done for me, it takes a bit but it works....
<br />
<br />Your nurse or doctor can change the diagnoses code also, it is just red tape, it stinks but it can be worked through. The nurses have been great about doing it for me.
 
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JustDucky

New member
That's just nuts....I too have Medicare but I have never been denied coverage for my lancets, strips etc for my diabetes. I get my stuff from Liberty, they send 3 months worth of diabetes supplies and Medicare picks up 80% under part B, the remaining 20% is covered by my supplemental insurance. Maybe you should have your doctor simply call it diabetes instead of CFRD, that way you will be covered. It is really odd that Medicare denied coverage for CFRD, it is diabetes so there should not be any issues. My doc just writes diabetes for diagnosis instead of CFRD. I would appeal this, it should have been covered.

Jenn 39 w/CF
 
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JustDucky

New member
That's just nuts....I too have Medicare but I have never been denied coverage for my lancets, strips etc for my diabetes. I get my stuff from Liberty, they send 3 months worth of diabetes supplies and Medicare picks up 80% under part B, the remaining 20% is covered by my supplemental insurance. Maybe you should have your doctor simply call it diabetes instead of CFRD, that way you will be covered. It is really odd that Medicare denied coverage for CFRD, it is diabetes so there should not be any issues. My doc just writes diabetes for diagnosis instead of CFRD. I would appeal this, it should have been covered.

Jenn 39 w/CF
 
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JustDucky

New member
That's just nuts....I too have Medicare but I have never been denied coverage for my lancets, strips etc for my diabetes. I get my stuff from Liberty, they send 3 months worth of diabetes supplies and Medicare picks up 80% under part B, the remaining 20% is covered by my supplemental insurance. Maybe you should have your doctor simply call it diabetes instead of CFRD, that way you will be covered. It is really odd that Medicare denied coverage for CFRD, it is diabetes so there should not be any issues. My doc just writes diabetes for diagnosis instead of CFRD. I would appeal this, it should have been covered.
<br />
<br />Jenn 39 w/CF
 
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ej0820

New member
hmmm...I always use Walgreen's for my test strips and they're always cheap (or free). I did go for a long period of time where any time I'd get diabetes stuff, I'd have to pay around $30 for it at the Walgreens pharmacy, but a month later I would get a refund check. What part of medicare is being billed, do you know? I realized I was being billed $30 each time I picked up my test strips and getting refunded that amount later because my medicare part D was covering that money later in the month. Now, all my prescriptions are free. I don't, however know if medicare thinks I have type 1 diabetes or knows it's CFRD. I have had problems with them covering my insulin pump supplies if it's been over 2 1/2 - 3 months since I've been to the endocrinologist. Medicare really seems to pay attention to diabetes care, so be advised that if it's been a while since you've seen your endocrinologist/CFRD doc, they may refuse to pay for ANYTHING until you do.<br>
 
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ej0820

New member
hmmm...I always use Walgreen's for my test strips and they're always cheap (or free). I did go for a long period of time where any time I'd get diabetes stuff, I'd have to pay around $30 for it at the Walgreens pharmacy, but a month later I would get a refund check. What part of medicare is being billed, do you know? I realized I was being billed $30 each time I picked up my test strips and getting refunded that amount later because my medicare part D was covering that money later in the month. Now, all my prescriptions are free. I don't, however know if medicare thinks I have type 1 diabetes or knows it's CFRD. I have had problems with them covering my insulin pump supplies if it's been over 2 1/2 - 3 months since I've been to the endocrinologist. Medicare really seems to pay attention to diabetes care, so be advised that if it's been a while since you've seen your endocrinologist/CFRD doc, they may refuse to pay for ANYTHING until you do.<br>
 
E

ej0820

New member
hmmm...I always use Walgreen's for my test strips and they're always cheap (or free). I did go for a long period of time where any time I'd get diabetes stuff, I'd have to pay around $30 for it at the Walgreens pharmacy, but a month later I would get a refund check. What part of medicare is being billed, do you know? I realized I was being billed $30 each time I picked up my test strips and getting refunded that amount later because my medicare part D was covering that money later in the month. Now, all my prescriptions are free. I don't, however know if medicare thinks I have type 1 diabetes or knows it's CFRD. I have had problems with them covering my insulin pump supplies if it's been over 2 1/2 - 3 months since I've been to the endocrinologist. Medicare really seems to pay attention to diabetes care, so be advised that if it's been a while since you've seen your endocrinologist/CFRD doc, they may refuse to pay for ANYTHING until you do.<br>
 
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JennifersHope

New member
@ Julie, if her nurses appeal and put in the right code for diagnoses, the chances of her getting approved are greatly increased. I am very well aware of the difference between Medicare and Medicaid... as I am living that right now.

Like Erin pointed out, in the meantime you can get a Walmart brand glucometer, the test strips usually run about fifty cents each... which is somewhat of a help.

I did a little diabetic education right before I stopped working and that is what we would tell people to use in the meantime while we appealed the insurance companies decision of denial, or what we had people who did not have insurance use.

I would still talk to your CF nurse or care nurse since they are pretty good usually at getting through the red tape.
 
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JennifersHope

New member
@ Julie, if her nurses appeal and put in the right code for diagnoses, the chances of her getting approved are greatly increased. I am very well aware of the difference between Medicare and Medicaid... as I am living that right now.

Like Erin pointed out, in the meantime you can get a Walmart brand glucometer, the test strips usually run about fifty cents each... which is somewhat of a help.

I did a little diabetic education right before I stopped working and that is what we would tell people to use in the meantime while we appealed the insurance companies decision of denial, or what we had people who did not have insurance use.

I would still talk to your CF nurse or care nurse since they are pretty good usually at getting through the red tape.
 
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