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SallyW

The Pump

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I was out cleaning out & putting to rest the gardens for the winter and UPS pulls in to deliver "Pumping Insulin." I started reading it over lunch, got to chapter 5 and the phone rings, it's the rep from Medtronics setting an appt at my dr's office for 11:00 the next morning. It's a sign!

I had a good meeting with him, he got all my insurance work submitted and it looks like I'll be meeting with the gal next week to get my pump and CGM. I was doing some research on different kinds of pumps, which CGMs work with them and, most importantly, learned about what Medicare covers. I'm good on my insurance until March, then I'm on Medicare.

I learned last night that the Dexcom G5 is the only CGM covered by Medicare. This is not the one that works with the Medtronics 670G. I'm waiting to find out what the cost is for the sensors for the CGM that comes with the Metronics system.

Is anyone currently on the Medtronics system and having to pay for the sensors??

I looked into the Tandem system but the Medtronics system seems to work the way I want/need it to.

 

Thank you for guiding me to "Pumping Insulin." It's already got notes, underlines and questions!

 

 

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Are you looking to buy the 670g? The closed loop system? You should look up the recent thread started by notme and her experience with it. Notme is an experienced pumper. You might even wish to contact her afterwards to ask her any questions you may have. I am sure she will gladly share what she knows.

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Thank you! I'll look her up. And yes, it was the 670G that I had the meeting about. It's with a Guardian CGM and that's the one that works with the system but Medicare doesn't cover.

I'll look up Notme's post and find her info. Thanks!

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Well I found some very interesting conversations for sure. The Animas was looking like such a great choice.... until I read further.

I have a lot of questions for the Medtronic guy. I'm really concerned about their support. Also concerned about Medicare coverage.
Nora did you say you are on Medicare and the supplemental ins? Do you have a CGM?

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Medtronic support is top notch so not sure why you are concerned there, their pumps as well are top of the line but their CGM/Sensors are garbage (they did however state they've made great strides in this area but I threw in the towel years ago). Everybody seems to love Dexcom in CGM arena but I have no personal experience with them, only Medtronic. 

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On 11/11/2017 at 8:41 PM, SallyW said:

 

 

I have a lot of questions for the Medtronic guy. I'm really concerned about their support. Also concerned about Medicare coverage.
 

It's been a while since I was a pumper, but I always found the Medtronic support to be very good. Good responses to my questions, good response when I had a problem with a delivery or the quality of a product, and good service when it came to loaner pumps (never any problems at all the 4 or 5 times I did it).

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On 11/11/2017 at 7:41 PM, SallyW said:

Nora did you say you are on Medicare and the supplemental ins? Do you have a CGM?

Yes, I am on Medicare plus a supplemental insurance. No, the CGM was not approved as necessary equipment by Medicare until early 2017 and I got my new pump in 2016. To buy out-of-pocket, the initial cost plus the cost of monthly supplies were more than I could comfortably pay. From what I hear, Dexcom does seem to be the dependable CGM right now. I am in the process of recalibrating my Ping. As soon as I get all my ratios to my satisfaction, I may start thinking about applying for a CGM. To tell the truth, I hate the thought of hanging another piece of equipment on my body. I am hoping that by the time I have to make an alternate pump selection, there will be more and better choices on the market. In the meantime, I will continue to use my Ping in the best manner I can.

 

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My concern about support was after reading comparison comments of the top 3 pumps, Medtronics, OmniPod & Tandem. If 3, right off the top, here say there's no problem then I have no concerns.

I got a text from the Medtronics rep this morning answering some of my questions:

How long does it take to get put on the Medtronics system?   This could take 2-3 weeks

Set backs from hurricane in Puerto Rico:   It looks like we are still having some issues with the CGM and sensors. I was told yesterday that it most likely wouldn’t be until March before orders place now would get their CGM and sensors due to the issues in Puerto Rico. 

He's also getting me the out of pocket costs for the portions I'll probably end up having to pay.

Nora: " I hate the thought of hanging another piece of equipment on my body. "

I wonder about this all the time! I don't know what it's going to be like having stuff attached to my body like this. I won't know until it's happening.

The way the rep explained how their CGM sends the readings to the pump sounded like the way I want to go. I'm not crazy about the shots, but I hate the finger picks the most. And to be really accurate with doses I understand that I need to know the readings, like a minimum of 5 or 6 picks a day. The way their CGM works with the pump takes all the guess work out of it. I only do finger picks to keep the CGM calibrated a couple of times a day.

So if I'm on the Medtronics pump and the Dexcom CGM, It's my understanding that I do all the readings from the CGM, figure out the carb or high bolus dose I need and put that information into the pump. Is that correct? Right now when I have a high reading at night before bed, I don't do the Novalog shot because that's a guarantee that I'll go way low in the middle of the night. The lowest dose I can give myself with the pen is 1 unit, so I do nothing. The pump gives a much lower dose to bring it down.

He also explained that they work only with the basal in the beginning to get that background dose set first. I was reading in Pumping Insulin that that's pretty intensive as far as readings (picks) day and night until the exact dose is found.

Something tells me I'm not really going to understand how all this works until I have it all hanging off my body and I'm poking the buttons!

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My understanding is that the Medtronics pumps work with their own Medtronics CGMs and not Dexcom. If you use a Dexcom, then the 670g won't work in a closed loop. This is my impression from what I have read online. Read up on the different systems and call each manufacturer to confirm your understanding before you make your decision.

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The closed loop Medtronics 670 requires the use of their Gusrdian sensors.

 

I called Medtronic today to follow up on my priority upgrade from 630 to 670 and was advised that the PR factory is back up and running and according to a directive received from above, the rep has been authorized to advise that all priority upgrade orders will be fulfilled by the 24th of next month. I have been waiting since March.

 

Other than the referenced delay, I have been very satisfied with the service and support I have received over past seven plus years. Medicare does not cover sensor supplies; however, My supplemental insurance covers 80 %. I believe, once the Medtronic CGMS has been proven to be safe, Medicare will start to cover it.

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Don, may I ask, did you go with Plan F or Plan G and which supplemental you have?

I am not signed up, well, I'm not on Medicare yet but I've had all the meetings to decipher what all the mail I receive means. When i get my card I will make the decision about which supplemental ins. to go with. Mine begins March 1st. Until then I'm on Anthem.

 

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Not that familiar as to what Plan F and G are. As far as I know, I am on Plan B with United Health Care supplemental through my former employer.

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Plan B is part of Medicare and covers such things as in-hospital care and medical equipment and supplies for such medical equipment. It also covers the insulin that goes into an insulin pump. Part B is part of Medicare and you can opt for at the time you sign up. Cost is deducted from your Social Security payments and amounts to about $1,200 per year.

Edited by NoraWI
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Thank you Nora! Clears that up. A and B are a given, I'll be on those. It's the F & G that's the supplement stuff and I didn't know which one determines diabetes supplies and Rx's. Oh yeah, then there's Part D for prescriptions.....Get's SO confusing!

So the pump research has gotten even more interesting. I've watched youtubes til I'm about to go blind!! I have found out that the Tandem Tslim X2 system works with the Dexcom CGM exactly like what I was counting on with the Medtronics system working with their CGM (which isn't available until 3/18). Whodathunk I'd get excited about pumps and CGMs.

Going with Tandem + Dexcom I won't have to make any changes next year when they switch me over to Medicare. One more concern to eliminate.

GrammaBear, If you're reading I would like to hear what you have to say about the Tandem system. I saw in another thread somewhere along the line that you're on a Tandem.

 

 

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Let me know how excited you are when the first door knob gets yeah, haha! 

Edited by Bar&In

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Doorknob attacked me only once in 8 years :o.

Sally, you may want to wait and do MDI until you qualify for Medicare next year because Medicare will actually buy you your pump. In the meantime, you will get the hang of counting carbs and your insulin to carb ratio, etc. on the Multiple Daily Injections. Used to be you had to go through that before you could even be considered for a pump. You will be much better prepared to integrate pump and CGM into your diabetes management. BTW, I, too am looking at the T-slim for down the road.

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4 hours ago, Bar&In said:

Let me know how excited you are when the first door knob gets yeah, haha! 

I'm not sure I want to know what this means lol.

 

So if I wait to go on the system until I'm on Medicare they'll pay 100% for the pump? Without meeting the deductible? Or the 80/20 thing?

My PC sent me to a nutritionist last year and spent hours learning how and what to & not to eat. I've been doing the carb counting, keeping a meal/carb diary since, early this year. It feels obsessive, but I have a daily diary of everything I eat, the carb count, the insulins I take and my BGs before & after. I'm waiting for all that information to just be a second nature, knowing the carbs I'm eating. That hasn't kicked in yet. I've also figured my insulin:carb ratio. I certainly haven't mastered either one, but I'm diligent in working with them. The one thing I haven't figured out is how much one unit of bolus insulin will drop my blood sugar. That changed every time I tried to gauge it.

From what I'm learning from the pump people this doesn't just happen over night. I'll be lucky to have anything by the end of this year. And then on March 1st I go on Medicare so depending on that transition I may be forced to wait anyway. I have no idea how all this works but the process appears to take several weeks at the least.

 

The more I see & learn of the Tandem, the more I like it. I've talked with them a couple of times and I'm just real impressed.

 

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Here is my take on all of this.   If you can get the Medtronic 670g, do it.  The 670 is worth the wait for the CGM in March of next year.  They are back ordered because of the hurricane in PR.  The tandem pump is much older technology and it is not a closed loop system.  While I am sure it is a fine pump, I would try and get the closed loop system first.  It is true, you can only use Guardian sensors with the 670g however, the Guardian system is excellent and I don’t say that easily.  I also used the CGM with the 630g with enlite sensors and they were very inaccurate.  The Guardian sensors are very very accurate and lasts for 7 days and I have pushed them by restarting them as a new sensor to 12 days.  I have heard of a few people who have pushed them two weeks.  As we speak I am trying a restart on my seven day old sensor.  So they may cost more, but you can use them a long time.  

 

A closed loop system (once the pump learns your needs) is amazing.  My A1c has gone from in the mid 8 range to 6.2 and I think I can actually get to a solid 6.   You will have a hard time achieving that without a lot of lows with any other pump or on MDI.

 

This pump has has been a challenge of a learning curve but I think it is worth it.  I was not one of the immediate fans but I am seeing amazing progress with a lot of determination.   I do know there are many people on Medicare who got the pump covered.  The hard part with Medicare is getting the CGM covered.  But several have succeeded  with a letter of medical necessity from their doctor.  

 

Don’t settle when it comes to your health.  Right now, like it or not, Medtronic is making huge strides in diabetes care.  Of course if it is impossible pumping is still the best thing for type ones out there.  But I would fight for the newest technology.

 

If you have Facebook, there is a page for 670g users and people who are trying to get the system.  They will help you with Medicare questions.  They have helped me immensely with the transition to the 670g and with any questions about settings or extending sensors.  They have been a God send.  

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Thank You, Thank You!! That's the best review of the Medtronics system I've read yet!

I just got a message from my PC:
"With the Tandem TslimX2 and Dexcom CGM, they are not contracted through the health council they can not come here for appointments to help, just something to think about."

I haven't heard anymore from the Medtronics rep but my PC said he's been working with her getting my information together from her.

 

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