Medicare / Humana Gold

[_]

- - -

Started on that November 1 2020. I've been
successful at getting everything I've needed
in the way of Insulinitis (Islit) supplies since
then, with the exception of my Dexcom G6
continuous glucose monitor sensors and
my Dexcom G6 transmitter.

Under my former health insurance, the after
insurance costs for those were
Dexcom G6 Transmitter $120.00
Dexcom G6 Sensors (3 month supply) $55.81

When I ordered them from Humana Pharmacy
on January 6 2021, the after insurance costs
they quoted were
DEXCOM G6 TRANSMITTER KIT: $262.80
DEXCOM G6 SENSOR (3 months supply): $365.76

They said for a less expensive price, I needed
insurance authorization. I've been trying to get
that for over a month, now. They had me see
what they call a Primary Care Provider today,
a doctor I've never seen, to get that insurance
authorization.

I've got to call him Monday to figure out what
he's done.

So, Humana Gold / Medicare, thumbs up in ALL
areas EXCEPT their handling of my need to use
a Dexcom G6 continuous glucose monitor. Every-
thing else, my endocrinologist was able to pre-
scribe what I needed, but for reasons unknown,
they made me see another doctor to try to get ...

... a less expensive price for Dexcom G6 supplies.
Go figure.

- - -

p.s. My dad lucked out and got his 1st Covid-19
vaccination today. I'm still awaiting word on when
I can get my 1st Covid-19 vaccination.

- - -

! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ !

Pro-Humanist FREELOVER, Freethinking
Realist Exploring Expressive Liberty,
Openness, Verity, Enlightenment, and
Rationality, hoping for a day when all
human ills are overcome and peace, ...

... love, joy, and happiness fills our
lives with boundless enthusiasm for
being the best we all can be in an
everlasting manner if possible !!!

I was diagnosed with Islit (Insulinitis)
caused by Insulitis (autoimmune attack
on pancreatic beta cells) at age 5, in
March, 1961, Insulitis Islit just 1 of
the 13 specific types of Islit.

Exogenous Insulin & Bloodprick / CGM
Glucose Tests History - 1961 to 2019
https://groups.google.com/d/msg/misc.health.diabetes/OlsPPpa2PAs/zQKVMjMnAQAJ

- - -

Superior Clarifying Names first created
and defined in May 2010, trying to replace
outdated anachronistic confusing misleading
diabetes / diabetic / reactive hypoglycemia
words and phrases:

Diabetes Bubble / Diabetes Bubble Burst
Exemplary! https://prohuman.net/diabetesbubblediabetesbubbleburst.htm

C.ure I.nsulinitis A.ssociation
Outstanding! https://prohuman.net/cureinsulinitisassociation.htm

Glucose Anomalies Research regarding
Potential Cures / Improvements in Treatments
Sooner is Ideal! https://prohuman.net/glucoseanomaliesresearch.htm

! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ !

[_]

- - -

Follow-up: Dexcom G6 Transmitter + 3 month
supply of -9- Dexcom G6 Sensors, when my
Primary Care Provider doctor that I saw
for the first time Friday, February 5, was
per my instructions supposed to order my
Dexcom G6 transmitter and sensors (9, ...

... 3 month supply), he for reasons unknown
did not do what they call a 'transferral',
which he told me was next to impossilbe to
get approved and he didn't seem to have any
idea why, but instead sent a prescription
to Humana Pharmacy. They came up with the
following prices:

DEXCOM G6 TRANSMITTER KIT: $262.80

DEXCOM G6 SENSOR (3 months supply): $1,073.28
TOTAL: $1,336.08

After spending the better part of a day
trying to figure what was going on at
Humana Pharmacy, I finally, via 2 chats,
was connected with a part of Humana called
Clinical Intake Team, and after talking to
1 lady, I finally was connected to a lady ...

... who informed me that the Dexcom G6
CGM is Durable Medical Equipment, and my
doctornhas to do what is called a "transferral"
and send that to a company called "One Home
Care Solutions". When I called my doctor back
this afternoon, the "transfer lady" told me that ...

... she faxed the "transferral" for the Dexcom
G6 Transmitter and 9 sensors (3 month sup-
ply) to "One Home Care Solutions" who has to
call me and talk to me before deciding whether
or not they'll approve that "transferral" request.

So, I'm in "wait mode", and since the lady at
Clinical Intake Team was kind enough to give
me the phone number for "One Home Care Solu-
tions", if they don't call me tomorrow morning,
I'm calling them to see if I can jump through
the final hoops (seems like I've jumped ...

... through at least 1,000 hoops thus far) to
be approved for the continuous glucose monitor
supplies I desperately need. I have no idea
what their price will be. I must say that the
entities responsible for this nightmarish pro-
cess that I've been working on for the past 40 ...

... days & nights (sounds biblical, doesn't it?)
should be ____?____ (insert appropriate pun-
ishment/condemnation) for coming up with
something so utterly idiotic/difficult/insulting
to reason & intelligence.

I'll follow this post up with information on
pricing -if- I'm approved, or information on
what may end up being the cause of my
death if the prices are too high that I can't
afford it -or- if they refuse my request for
something that's helped to keep me alive ...

... since October, 2013 (well-documented
in this newsgroup, the innumerable severe
hypoglycemia incidents that came close to
killing me prior to my getting a continuous
glucose monitor).

- - -

On Friday, February 5, 2021 at 6:30:28 PM UTC-6, _ wrote:

.> - - -
.>
.> Started on that November 1 2020. I've been
.> successful at getting everything I've needed
.> in the way of Insulinitis (Islit) supplies since
.> then, with the exception of my Dexcom G6
.> continuous glucose monitor sensors and
.> my Dexcom G6 transmitter.
.>
.> Under my former health insurance, the after
.> insurance costs for those were
.> Dexcom G6 Transmitter $120.00
.> Dexcom G6 Sensors (3 month supply) $55.81
.>
.> When I ordered them from Humana Pharmacy
.> on January 6 2021, the after insurance costs
.> they quoted were
.> DEXCOM G6 TRANSMITTER KIT: $262.80
.> DEXCOM G6 SENSOR (3 months supply): $365.76
.>
.> They said for a less expensive price, I needed
.> insurance authorization. I've been trying to get
.> that for over a month, now. They had me see
.> what they call a Primary Care Provider today,
.> a doctor I've never seen, to get that insurance
.> authorization.
.>
.> I've got to call him Monday to figure out what
.> he's done.
.>
.> So, Humana Gold / Medicare, thumbs up in ALL
.> areas EXCEPT their handling of my need to use
.> a Dexcom G6 continuous glucose monitor. Every-
.> thing else, my endocrinologist was able to pre-
.> scribe what I needed, but for reasons unknown,
.> they made me see another doctor to try to get ...
.>
.> ... a less expensive price for Dexcom G6 supplies.
.> Go figure.
.>
.> - - -
.>
.> p.s. My dad lucked out and got his 1st Covid-19
.> vaccination today. I'm still awaiting word on when
.> I can get my 1st Covid-19 vaccination.
.>
.> - - -
.>
.> ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ !
.>
.> Pro-Humanist FREELOVER, Freethinking
.> Realist Exploring Expressive Liberty,
.> Openness, Verity, Enlightenment, and
.> Rationality, hoping for a day when all
.> human ills are overcome and peace, ...
.>
.> ... love, joy, and happiness fills our
.> lives with boundless enthusiasm for
.> being the best we all can be in an
.> everlasting manner if possible !!!
.>
.> I was diagnosed with Islit (Insulinitis)
.> caused by Insulitis (autoimmune attack
.> on pancreatic beta cells) at age 5, in
.> March, 1961, Insulitis Islit just 1 of
.> the 13 specific types of Islit.
.>
.> Exogenous Insulin & Bloodprick / CGM
.> Glucose Tests History - 1961 to 2019
.> https://groups.google.com/d/msg/misc.health.diabetes/OlsPPpa2PAs/zQKVMjMnAQAJ
.>
.> - - -
.>
.> Superior Clarifying Names first created
.> and defined in May 2010, trying to replace
.> outdated anachronistic confusing misleading
.> diabetes / diabetic / reactive hypoglycemia
.> words and phrases:
.>
.> Diabetes Bubble / Diabetes Bubble Burst
.> Exemplary! https://prohuman.net/diabetesbubblediabetesbubbleburst.htm
.>
.> C.ure I.nsulinitis A.ssociation
.> Outstanding! https://prohuman.net/cureinsulinitisassociation.htm
.>
.> Glucose Anomalies Research regarding
.> Potential Cures / Improvements in Treatments
.> Sooner is Ideal! https://prohuman.net/glucoseanomaliesresearch.htm
.>
.> ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ !

[Jim]

_ wrote:

> the Dexcom G6 CGM is Durable Medical Equipment (DME)

Dexcom's website says it stopped taking Medicare on 1 Sept 2020. This means
that Medicare would not pay the full price and Dexcom could not make a profit:

https://www.dexcom.com/faqs/medicare

Your Humana Gold gets paid by Medicare and they probably will not make a profit
either. So you've been transferred to a DME company that must fight Medicare
to get paid. They will probably not make a profit and will tell you you must pay.

I use Medicare Part D for meds. Part B would be used for DME. I doubt Medicare
would pay for this DME in Part B for me. But I don't need a CGM.

Medicare Advantage plans like Humana Gold are Medicare Part C. I've read T1Ds
have had to fight for insulin pumps and CGMs when on Medicare.

You may have to scale back your technology when on Medicare.
--
Jim
T1 4/86, no complications, watching for IGF-I positive feedback loop.
Nocturnal hypoglycemic seizures ended when stopped using Humalog (Lispro).
Normal Dawn Phenomenon returned ~1 year later.

[AntiPro&T1.1DM]

_ wrote:

> They had me see what they call a Primary Care Provider today,
> a doctor I've never seen, to get that insurance authorization.

If you're using dumb words like islit when talking to them, they think you and
your Endo are crazy. So they asked for a more knowledgeable opinion.

Using wrong terminology gets you into a cellosified Medicare rabbit hole.
--
APT1.1DM = SAID+T5 = SAID+(MARD/50) = T1.1, per Lancet 5 DM Groups.
Insulinitis = Insulitis: β-cell destruction by lymphocytes, not a disease name.
Islit, cellosis and diminosis are nonsense words used by 1 crazy person on Earth.

[AntiPro&T1.1DM]

AntiPro&T1.1DM wrote:

> Using wrong terminology gets you into a cellosified Medicare rabbit hole.

You need to learn the correct medical terminology, as your life depends on it.

If you fail to medically communicate properly, it could kill you.

[_]

On Sunday, February 14, 2021 at 11:44:05 AM UTC-6, Jim wrote:
/> _ wrote:
/>
/> > the Dexcom G6 CGM is Durable Medical Equipment (DME)

.> Dexcom's website says it stopped taking Medicare on 1 Sept 2020. This means
.> that Medicare would not pay the full price and Dexcom could not make a profit:
.>
.> https://www.dexcom.com/faqs/medicare
.>
.> Your Humana Gold gets paid by Medicare and they probably will not make a profit
.> either. So you've been transferred to a DME company that must fight Medicare
.> to get paid. They will probably not make a profit and will tell you you must pay.
.>
.> I use Medicare Part D for meds. Part B would be used for DME. I doubt Medicare
.> would pay for this DME in Part B for me. But I don't need a CGM.
.>
.> Medicare Advantage plans like Humana Gold are Medicare Part C. I've read T1Ds
.> have had to fight for insulin pumps and CGMs when on Medicare.
.>
.> You may have to scale back your technology when on Medicare.
.> --
.> Jim

Thanks for the info, Jim. I found out that the
company the Humana Clinical Intake Team
said covered the CGM, "One Home Care Sol-
utions", does -not- cover the CGM, so I con-
tacted CCS Medical https://ccsmed.com , they
set me up as a patient and said they will ...

... contact Humana Gold for my insurance ver-
ification, will contact my endocrinologist for
information for a work order for Dexcom G6
transmitter + 9 sensors, will call me with a
price, and if I approve, will ship it to me UPS
ground.

That 3-step process sounded good, but they
then sent me an email with a 6-step process,
so I'm calling them tomorrow to see what's
going on (if anything). I also contacted ano-
ther supplier, US Med, and am awaiting an
email reply / phone call from them.

If those don't get the CGM for me, I've also
applied for a switch back to Medicare Part
A & B coverage, so I hope that 1 of those
3 pursuits results in 80% coverage which
may result in 3 month CGM supplies costing
around $280. That's higher than I'd like ...

... but way better than over $1,300 every
3 months.

By the way, Humana Gold HMO Plus did
great on dental, 3-month insulin pump sup-
plies of $125, 3-month Fiasp insulin (5 vials)
for $125, 3-months of test strips & alcohol
swabs (did not find that they charged me for
those), so the CGM has been the sole item
I've struggled with.

. ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ ! ~ !

.
. Superior Clarifying Names first created &
. defined in 2010, trying to replace outdated
. anachronistic confusing misleading diabetes
. & diabetic & reactive hypoglycemia words &
. phrases:

[_]

Follow-up:

On Sunday, February 14, 2021 at 4:20:06 PM UTC-6, _ wrote:

.> Thanks for the info, Jim. I found out that the
.> company the Humana Clinical Intake Team
.> said covered the CGM, "One Home Care Sol-
.> utions", does -not- cover the CGM, so I con-
.> tacted CCS Medical https://ccsmed.com , they
.> set me up as a patient and said they will ...
.>
.> ... contact Humana Gold for my insurance ver-
.> ification, will contact my endocrinologist for
.> information for a work order for Dexcom G6
.> transmitter + 9 sensors, will call me with a
.> price, and if I approve, will ship it to me UPS
.> ground.

As of today, CCS Medical says their awaiting
word from my endocrinologist. Due to myself
and my endocrinologist and much of Texas
having lost power for several days starting
Monday due to severe cold weather & ERCOT
mismanagement & Texas power grid isolation, ...

... I haven't been able to reach my Endocrin-
ologist yesterday (having gotten power back
at 2 PM yesterday after having no power for
82 straight hours) and today. I'll try again
Monday.

The power outage, lost close to $200 in food
in my freezers and without power to the refrig-
erator for 82 hours, I had 9 vials of insulin
above the recommended refrigerated temper-
ature of 40 degrees during that time, and I ...

... won't know how effective they will be until
I use them vial-by-vial in the coming months.

.> That 3-step process sounded good, but they
.> then sent me an email with a 6-step process,
.> so I'm calling them tomorrow to see what's
.> going on (if anything). I also contacted ano-
.> ther supplier, US Med, and am awaiting an
.> email reply / phone call from them.
.>
.> If those don't get the CGM for me, I've also
.> applied for a switch back to Medicare Part
.> A & B coverage, so I hope that 1 of those
.> 3 pursuits results in 80% coverage which
.> may result in 3 month CGM supplies costing
.> around $280. That's higher than I'd like ...
.>
.> ... but way better than over $1,300 every
.> 3 months.
.>
.> By the way, Humana Gold HMO Plus did
.> great on dental, 3-month insulin pump sup-
.> plies of $125, 3-month Fiasp insulin (5 vials)
.> for $125, 3-months of test strips & alcohol
.> swabs (did not find that they charged me for
.> those), so the CGM has been the sole item
.> I've struggled with.

^ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ -
^
^ Pro-Humanist FREELOVER, Freethinking
^ Realist Exploring Expressive Liberty,
^ Openness, Verity, Enlightenment, &
^ Rationality
^
^ I've had Islit (Insulinitis, near-total to
^ total loss of endogenous insulin) since
^ age 5, getting it over 58 years ago, in
^ March 1961.
^
^ o 13 specific types of rapid onset Islit
^
^ o 1 slow onset type, Latent Autoimmune Islit
^
^ - - -
^ diabetes / diabetic without a clarifier,
^ diabetes / diabetic guessing required
^ https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
^ - - -
^
^ Support for the Potential of
^ My Efforts to Put an End to
^ Diabetes / Diabetic / Reactive
^ Hypoglycemia Confusion With
^ Estimable Invaluable New
^ Superior Clarifying Names:
^
^ One Voice Can Change a Room,
^ a City, a State, a Nation,
^ THE WORLD
^ https://tinyurl.com/OneVoiceCan
^
^ Diabetes Bubble / Diabetes Bubble Burst
^ Fantastic! https://prohuman.net/diabetesbubblediabetesbubbleburst.htm
^
^ C.ure I.nsulinitis A.ssociation
^ Ideally! https://prohuman.net/cureinsulinitisassociation.htm
^
^ Glucose Anomalies Research regarding
^ Potential Cures / Improvements in Treatments
^ If only! https://prohuman.net/glucoseanomaliesresearch.htm
^
^ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ -

[_]

Follow-up 2:

On Friday, February 19, 2021 at 7:03:43 PM UTC-6, _ wrote:

.> Follow-up:
.>

.> On Sunday, February 14, 2021 at 4:20:06 PM UTC-6, _ wrote:
.>

.> As of today, CCS Medical says their awaiting
.> word from my endocrinologist. Due to myself
.> and my endocrinologist and much of Texas
.> having lost power for several days starting
.> Monday due to severe cold weather & ERCOT
.> mismanagement & Texas power grid isolation, ...
.>
.> ... I haven't been able to reach my Endocrin-
.> ologist yesterday (having gotten power back
.> at 2 PM yesterday after having no power for
.> 82 straight hours) and today. I'll try again
.> Monday.
.>
.> The power outage, lost close to $200 in food
.> in my freezers and without power to the refrig-
.> erator for 82 hours, I had 9 vials of insulin
.> above the recommended refrigerated temper-
.> ature of 40 degrees during that time, and I ...
.>
.> ... won't know how effective they will be until
.> I use them vial-by-vial in the coming months.

The latest hold-up, they had to know the name
of the insurance company that covered my cur-
rent Dexcom G6 Receiver and when I purchased
that. I found that out and informed CCS Medical.

Getting very close. CCS Medical today says they
anticipate final APPROVAL by Wednesday, and
will expedite shipment via 3-day UPS ground at
that time, presuming final approval transpires.

I'm down to my last 10-day sensor as I have to
change & use my 2nd-to-last sensor at 1:44 PM
today (30 minutes from now).

At one point one lady quoted a price of $155.52
for Dexcom G6 transmitter + 9 Dexcom G6 sen-
sors (3 months supply). The last phone call, ano-
ther lady quoted a price of $98 for those supplies,
so I'll soon find out what the actual price is.

Fingers-crossed, knock on wood.

~> ^ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ -
~> ^
~> ^ Pro-Humanist FREELOVER, Freethinking
~> ^ Realist Exploring Expressive Liberty,
~> ^ Openness, Verity, Enlightenment, &
~> ^ Rationality
~> ^
~> ^ I've had Islit (Insulinitis, near-total to
~> ^ total loss of endogenous insulin) since
~> ^ age 5, getting it over 58 years ago, in
~> ^ March 1961.
~> ^
~> ^ o 13 specific types of rapid onset Islit
~> ^
~> ^ o 1 slow onset type, Latent Autoimmune Islit
~> ^
~> ^ - - -
~> ^ diabetes / diabetic without a clarifier,
~> ^ diabetes / diabetic guessing required
~> ^ https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
~> ^ - - -
~> ^
~> ^ Support for the Potential of
~> ^ My Efforts to Put an End to
~> ^ Diabetes / Diabetic / Reactive
~> ^ Hypoglycemia Confusion With
~> ^ Estimable Invaluable New
~> ^ Superior Clarifying Names:
~> ^
~> ^ One Voice Can Change a Room,
~> ^ a City, a State, a Nation,
~> ^ THE WORLD
~> ^ https://tinyurl.com/OneVoiceCan
~> ^
~> ^ Diabetes Bubble / Diabetes Bubble Burst
~> ^ Fantastic! https://prohuman.net/diabetesbubblediabetesbubbleburst.htm
~> ^
~> ^ C.ure I.nsulinitis A.ssociation
~> ^ Ideally! https://prohuman.net/cureinsulinitisassociation.htm
~> ^
~> ^ Glucose Anomalies Research regarding
~> ^ Potential Cures / Improvements in Treatments
~> ^ If only! https://prohuman.net/glucoseanomaliesresearch.htm
~> ^
~> ^ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ - ~~ -

[_]

Follow-up 3:

On Monday, February 22, 2021 at 1:14:25 PM UTC-6, _ wrote:

.> The latest hold-up, they had to know the name
.> of the insurance company that covered my cur-
.> rent Dexcom G6 Receiver and when I purchased
.> that. I found that out and informed CCS Medical.
.>
.> Getting very close. CCS Medical today says they
.> anticipate final APPROVAL by Wednesday, and
.> will expedite shipment via 3-day UPS ground at
.> that time, presuming final approval transpires.
.>
.> I'm down to my last 10-day sensor as I have to
.> change & use my 2nd-to-last sensor at 1:44 PM
.> today (30 minutes from now).
.>
.> At one point one lady quoted a price of $155.52
.> for Dexcom G6 transmitter + 9 Dexcom G6 sen-
.> sors (3 months supply). The last phone call, ano-
.> ther lady quoted a price of $98 for those supplies,
.> so I'll soon find out what the actual price is.
.>
.> Fingers-crossed, knock on wood.

Today, I confirmed approval for the Dexcom G6
transmitter + 9 sensors (3 month supply) at an
out-of-pocket cost of $155.52. They're shipping
them overnight.

So, after a tedious trying near-2-month process
of jumping through hoops again and again trying
to get the above at a reasonable price, CCS Med-
ical appears to have delivered.

Aside from Humana steering me in an incorrect
direction & stating I had to see & get authorization
from a primary care provider (which turns out to
be untrue) and not informing me that the actual
entity I had to get the Dexcom G6 supplies from
was/is CCS Medical, Humana has given me an ...

... amazing low price for everything else. My lat-
est Fiasp insulin (5 vials) price = $95, free test
strips, free alcohol swabs, free lancets.

I'll soon see what my latest price is for 3 months
of Omnipod insulin pump insertions. If it's $125,
which is what it was on my first order, the total
price for all my Islit supplies for 3 months is
$155.52 + $95 + $125 = $375.52, which =
$125.17 per month ($1,502.04 per year).

~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~

INSULINITIS (ISLIT)

New SUPERIOR clarifying name for near-
total to total loss of endogenous insulin
https://prohuman.net/pix2/new_superior_clarifying_name_is_INSULINITIS.jpg

The overwhelming majority of Islit caused by
autoimmune attacks on pancreatic beta cells
(Insulitis Islit) but there are

o 13 specific types of rapid onset Islit, a
rare condition (only present in < one-half
of 1% of Americans & in a much lower rate
in most of the world), when present is typ-
ically diagnosed at age under 30
(50% at age < 18, 20% at age 19 to 29)

o 1 slow onset specific type, Latent Autoim-
mune Islit, frequency unknown but per a
recent report, misdiagnosed as Cellosis
(new clarifying name for type 2 diabetes)
almost 40% of the time due to its slow
onset and its occurrence typically at age
over 30

Old outdated anachronistic name for Islit is
type 1 diabetes, confusing in that diabetes
without clarifier is often used to describe
this condition which is 1 of the 7 Disparate
High Glucose Conditions (DHGCs).

That makes figuring out which DHGC is actu-
ally being referred to (and it can be any one,
or some, or all of them when the diabetes
or diabetic word is used without clarifier)
confusing / difficult:
https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
https://prohuman.net/pix2/diabetesdiabeticconfusion.jpg
https://prohuman.net/pix2/diabetesdiabeticendingthemisunderstanding.jpg

- - -

Insulin / Insulin Pump / CGM I use

Fiasp Ultra-Fast-Acting Insulin in a
tubeless Omnipod insulin pump catheter
placed into skin / pod with adhesive
stuck onto skin every 80 hours, control
via PDM (Personal Data Manager)
https://prohuman.net/pix2/Fiaspinsulin_tubelessOmnipodDASHinsulinpump.jpg

Dexcom G6 CGM (continuous glucose monitor)
https://prohuman.net/pix2/Dexcom_G6_CGM.jpg

~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~

[AntiPro&T1.1DM]

_ wrote:

> which = $125.17 per month ($1,502.04 per year

Your Fiasp will put you in the Medicare Donut Hole by itself. The retail price
of the insulin less 10-15% is used in the Donut Hole. Bot the co-pay price
you're looking at. Once in the Donut Hole, your $$ increases a lot. The
limit is $4130 this year. Not sure how your pump and CGM supplies will be
handled. Think the Donut Hole is only for meds.

So if Fiasp has a $300/vial pharmacy cost, $4130/$300 ~= 14 vials of Fiasp
before you get clobbered with higher costs.

The Donut Hole gets me in Nov-Dec each year. So I check with my pharmacist
on the phone before refills to see if I'm in the Donut Hole before refilling.

Since you're a Medicare newbee, you'll be Donut Hole road-kill this year.

[_]

On Thursday, February 25, 2021 at 4:52:53 PM UTC-6, AntiPro&T1.1DM wrote:
> _ wrote:
>
> > which = $125.17 per month ($1,502.04 per year
> Your Fiasp will put you in the Medicare Donut Hole by itself. The retail price
> of the insulin less 10-15% is used in the Donut Hole. Bot the co-pay price
> you're looking at. Once in the Donut Hole, your $$ increases a lot. The
> limit is $4130 this year. Not sure how your pump and CGM supplies will be
> handled. Think the Donut Hole is only for meds.
>
> So if Fiasp has a $300/vial pharmacy cost, $4130/$300 ~= 14 vials of Fiasp
> before you get clobbered with higher costs.
>
> The Donut Hole gets me in Nov-Dec each year. So I check with my pharmacist
> on the phone before refills to see if I'm in the Donut Hole before refilling.
>
> Since you're a Medicare newbee, you'll be Donut Hole road-kill this year.

Fiasp insulin vials, somehow during the freezing cold power outage
for 82 hours, I lost 1 and a half vials of Fiasp insulin, but right now,
I have 14 vials on hand. I'm using less insulin now as I'm on a low
calorie diet (about 30 units/day), so one vial lasts one month, and
as long as I stay on my diet, I won't need any more insulin in 2021
(presuming my unrefrigerated insulin during the power outage still
works well).

However, don't know how long I'll stay on the diet. Thus far, no hunger
probs, I'm down to 178.6 pounds, BMI 28.6 .

Omnipod Dash Pack 5s, 30 every 3 months, retail $1,542.39 . I have
52 pods on hand, will need 50 more to cover the last 5 months, so that's
around $3,085 (2 orders of 30 pods each for 6 months supply).

Dexcom G6 Sensors, 9 every 3 months, retail $1,033.94, I'll need to
order 3 month supplies of those in June, September, & December, so
that's around $3,100. Transmitters, retail $244.67, that's around $734.

From reading about the donut hole, Humana describes it at
https://www.humana.com/medicare/medicare-donut-hole-coverage-gap

It seems there's a 75% coverage between $4130 and $6,550, so if
true, I'd pay 25% of the difference ($2,420) which = $605 after reaching
$4130.

As I'm new to all this, not sure where the Omnipod & Dexcom CGM fit
in, or how all this works, but hey, I guess I'll learn once that happens
so it looks like my total in 2021 may end up being $1,502.04 + $605
or thereabouts, going from $125.17 per month -to- $175.58 per month.

Just guessing - if you see any mistakes I've made in interpretation of
all that, feel free to let me know.

. ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~

.
. INSULINITIS (ISLIT)
.
. New SUPERIOR clarifying name for near-
. total to total loss of endogenous insulin
. https://prohuman.net/pix2/new_superior_clarifying_name_is_INSULINITIS.jpg
.
. The overwhelming majority of Islit caused by
. autoimmune attacks on pancreatic beta cells
. (Insulitis Islit) but there are
.
. o 13 specific types of rapid onset Islit, a
. rare condition (only present in < one-half
. of 1% of Americans & in a much lower rate
. in most of the world), when present is typ-
. ically diagnosed at age under 30
. (50% at age < 18, 20% at age 19 to 29)
.
. o 1 slow onset specific type, Latent Autoim-
. mune Islit, frequency unknown but per a
. recent report, misdiagnosed as Cellosis
. (new clarifying name for type 2 diabetes)
. almost 40% of the time due to its slow
. onset and its occurrence typically at age
. over 30
.
. Old outdated anachronistic name for Islit is
. type 1 diabetes, confusing in that diabetes
. without clarifier is often used to describe
. this condition which is 1 of the 7 Disparate
. High Glucose Conditions (DHGCs).
.

. That makes figuring out which DHGC is actu-

. ally being referred to (and it can be any one,
. or some, or all of them when the diabetes
. or diabetic word is used without clarifier)
. confusing / difficult:
. https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
. https://prohuman.net/pix2/diabetesdiabeticconfusion.jpg
. https://prohuman.net/pix2/diabetesdiabeticendingthemisunderstanding.jpg

.
. - - -
.

. Insulin / Insulin Pump / CGM I use
.
. Fiasp Ultra-Fast-Acting Insulin in a
. tubeless Omnipod insulin pump catheter
. placed into skin / pod with adhesive
. stuck onto skin every 80 hours, control
. via PDM (Personal Data Manager)
. https://prohuman.net/pix2/Fiaspinsulin_tubelessOmnipodDASHinsulinpump.jpg
.
. Dexcom G6 CGM (continuous glucose monitor).
. https://prohuman.net/pix2/Dexcom_G6_CGM.jpg
.

[_]

One follow-up: Omnipod Horizon (Omnipod closed loop insulin
dosing auto-adjusted based on Dexcom G6 glucose readings)
may be available in the 2nd half of 2021. If so, that might impact
the previous figures as the Dexcom G6 may transfer from a
durable medical equipment device to a pharmacy device, and
not sure how that would play in the "fun-with-math-&-money"
arena discussed in my previous post:
https://www.omnipod.com/healthcareproviders/about-omnipod/innovation

On Thursday, February 25, 2021 at 7:23:59 PM UTC-6, _ wrote:

~> Fiasp insulin vials, somehow during the freezing cold power outage
~> for 82 hours, I lost 1 and a half vials of Fiasp insulin, but right now,
~> I have 14 vials on hand. I'm using less insulin now as I'm on a low
~> calorie diet (about 30 units/day), so one vial lasts one month, and
~> as long as I stay on my diet, I won't need any more insulin in 2021
~> (presuming my unrefrigerated insulin during the power outage still
~> works well).
~>
~> However, don't know how long I'll stay on the diet. Thus far, no hunger
~> probs, I'm down to 178.6 pounds, BMI 28.6 .
~>
~> Omnipod Dash Pack 5s, 30 every 3 months, retail $1,542.39 . I have
~> 52 pods on hand, will need 50 more to cover the last 5 months, so that's
~> around $3,085 (2 orders of 30 pods each for 6 months supply).
~>
~> Dexcom G6 Sensors, 9 every 3 months, retail $1,033.94, I'll need to
~> order 3 month supplies of those in June, September, & December, so
~> that's around $3,100. Transmitters, retail $244.67, that's around $734.
~>
~> From reading about the donut hole, Humana describes it at
~> https://www.humana.com/medicare/medicare-donut-hole-coverage-gap
~>
~> It seems there's a 75% coverage between $4130 and $6,550, so if
~> true, I'd pay 25% of the difference ($2,420) which = $605 after reaching
~> $4130.
~>
~> As I'm new to all this, not sure where the Omnipod & Dexcom CGM fit
~> in, or how all this works, but hey, I guess I'll learn once that happens
~> so it looks like my total in 2021 may end up being $1,502.04 + $605
~> or thereabouts, going from $125.17 per month -to- $175.58 per month.
~>
~> Just guessing - if you see any mistakes I've made in interpretation of
~> all that, feel free to let me know.

~> . ~~~ ~~~ ~~~ ~~~ ~~~ ~~~
~> .
~> . INSULINITIS (ISLIT)
~> .
~> . New SUPERIOR clarifying name for near-
~> . total to total loss of endogenous insulin
~> . https://prohuman.net/pix2/new_superior_clarifying_name_is_INSULINITIS.jpg
~> .
~> . The overwhelming majority of Islit caused by
~> . autoimmune attacks on pancreatic beta cells
~> . (Insulitis Islit) but there are
~> .
~> . o 13 specific types of rapid onset Islit, a
~> . rare condition (only present in < one-half
~> . of 1% of Americans & in a much lower rate
~> . in most of the world), when present is typ-
~> . ically diagnosed at age under 30
~> . (50% at age < 18, 20% at age 19 to 29)
~> .
~> . o 1 slow onset specific type, Latent Autoim-
~> . mune Islit, frequency unknown but per a
~> . recent report, misdiagnosed as Cellosis
~> . (new clarifying name for type 2 diabetes)
~> . almost 40% of the time due to its slow
~> . onset and its occurrence typically at age
~> . over 30
~> .
~> . Old outdated anachronistic name for Islit is
~> . type 1 diabetes, confusing in that diabetes
~> . without clarifier is often used to describe
~> . this condition which is 1 of the 7 Disparate
~> . High Glucose Conditions (DHGCs).
~> .
~> . That makes figuring out which DHGC is actu-
~> . ally being referred to (and it can be any one,
~> . or some, or all of them when the diabetes
~> . or diabetic word is used without clarifier)
~> . confusing / difficult:
~> . https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
~> . https://prohuman.net/pix2/diabetesdiabeticconfusion.jpg
~> . https://prohuman.net/pix2/diabetesdiabeticendingthemisunderstanding.jpg
~> .
~> . - - -
~> .
~> . Insulin / Insulin Pump / CGM I use
~> .
~> . Fiasp Ultra-Fast-Acting Insulin in a
~> . tubeless Omnipod insulin pump catheter
~> . placed into skin / pod with adhesive
~> . stuck onto skin every 80 hours, control
~> . via PDM (Personal Data Manager)
~> . https://prohuman.net/pix2/Fiaspinsulin_tubelessOmnipodDASHinsulinpump.jpg
~> .
~> . Dexcom G6 CGM (continuous glucose monitor).
~> . https://prohuman.net/pix2/Dexcom_G6_CGM.jpg
~> .
~> . ~~~ ~~~ ~~~ ~~~ ~~~ ~~~

[AntiPro&T1.1DM]

_ wrote:

> if you see any mistakes I've made in interpretation

The Donut Hole uses a different price for meds then what you pay at the
pharmacy as a co-pay. This price is the "negotiated" price by the Pharmacy
Benefits Manager (PBM). This negotiated price could change mid-year as well.
So your numbers seem to always be low each time you try to project the
Donut Hole threshold.

As an example, last year Tresiba retail price was $403/10mL vial. I paid $47
as the co-pay at the pharmacy. The Medicare Part D summary the following
month (paperwork always a month later) said the negotiated price was just
less than $350 that was taken against my 2020 Donut Hole of $4020.

My calculations in Dec 2020 said I still had $600 left before the Donut Hole
threshold. I called the pharmacy and asked them to tell me the cost of a
Tresiba refill. It was already in the Donut Hole. I told the pharmacist I'll
wait until 2021 to refill and thanked him for his help. Tresiba and Novolog
are the only meds I have that go into Donut Hole calculations. Generic meds
(Tier 1 and 2 meds) do not go against the Donut Hole.

To make matters worse, my Part D summary for November came Jan 2021.
A month later than usual. Guess the USPS was messed up with Trump's new
appointee hosing up the system. When snailmail breaks, the News of the
World breaks too, as your bills and income checks are now late.

In any case, your numbers are not the numbers they use in the Donut Hole.

[_]

- - -

Follow-up 4: I'm elated, I got all of my desperately needed
Dexcom G6 supplies (transmitter + 9 sensors) today, but
the most surprising thing (thus far), guess what's showing
up on my bank account.

CCS Medical charged me 1 penny. What? 1 penny? What
in the world is going on? Oh well, maybe the $155.52 they
said they were going to charge will show up later today or
tomorrow.

Humana Pharmacy includes all details of list prices and
what they charge in their shipments. CCS Medical did not
include any of the prices, so the prices I've quoted were
from old information regarding Dexcom G6 orders back
when I was using Express Scripts on my former insurance.

The Dexcom G6 transmitter box has highlighted in orange
2 labels that say "Medicare/Medicaid DME Beneficiary Only".

The Dexcom G6 sensor boxes has highlighted in orange
2 labels that say "For DME Distribution Government Payors
Only".

I wonder if since this is classified as Durable Medical Equip-
ment, the retail price won't count towards my pharmacy donut
hole at $4130.

- - -

Gleeful Islit (Insulinitis, near-total to total loss of endogenous
insulin) individual, thus far charged 1 penny for all of the above
Dexcom G6 supplies.

~ ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- !
~ Superior Clarifying Names first created
~ and defined in May 2010, trying to replace
~ outdated anachronistic confusing misleading
~ diabetes / diabetic / reactive hypoglycemia
~ words and phrases:
~
~ Diabetes Bubble / Diabetes Bubble Burst
~ Exemplary! https://prohuman.net/diabetesbubblediabetesbubbleburst.htm
~
~ C.ure I.nsulinitis A.ssociation
~ Outstanding! https://prohuman.net/cureinsulinitisassociation.htm
~
~ Glucose Anomalies Research regarding
~ Potential Cures / Improvements in Treatments
~ Sooner is Ideal! https://prohuman.net/glucoseanomaliesresearch.htm
~ ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- ! -- !

On Thursday, February 25, 2021 at 4:27:58 PM UTC-6, _ wrote:

~> Follow-up 3:
~>
~> On Monday, February 22, 2021 at 1:14:25 PM UTC-6, _ wrote:
~>
~> .> The latest hold-up, they had to know the name
~> .> of the insurance company that covered my cur-
~> .> rent Dexcom G6 Receiver and when I purchased
~> .> that. I found that out and informed CCS Medical.
~> .>
~> .> Getting very close. CCS Medical today says they
~> .> anticipate final APPROVAL by Wednesday, and
~> .> will expedite shipment via 3-day UPS ground at
~> .> that time, presuming final approval transpires.
~> .>
~> .> I'm down to my last 10-day sensor as I have to
~> .> change & use my 2nd-to-last sensor at 1:44 PM
~> .> today (30 minutes from now).
~> .>
~> .> At one point one lady quoted a price of $155.52
~> .> for Dexcom G6 transmitter + 9 Dexcom G6 sen-
~> .> sors (3 months supply). The last phone call, ano-
~> .> ther lady quoted a price of $98 for those supplies,
~> .> so I'll soon find out what the actual price is.
~> .>
~> .> Fingers-crossed, knock on wood.

/> Today, I confirmed approval for the Dexcom G6
/> transmitter + 9 sensors (3 month supply) at an
/> out-of-pocket cost of $155.52. They're shipping
/> them overnight.
/>
/> So, after a tedious trying near-2-month process
/> of jumping through hoops again and again trying
/> to get the above at a reasonable price, CCS Med-
/> ical appears to have delivered.
/>
/> Aside from Humana steering me in an incorrect
/> direction & stating I had to see & get authorization
/> from a primary care provider (which turns out to
/> be untrue) and not informing me that the actual
/> entity I had to get the Dexcom G6 supplies from
/> was/is CCS Medical, Humana has given me an ...
/>
/> ... amazing low price for everything else. My lat-
/> est Fiasp insulin (5 vials) price = $95, free test
/> strips, free alcohol swabs, free lancets.
/>
/> I'll soon see what my latest price is for 3 months
/> of Omnipod insulin pump insertions. If it's $125,
/> which is what it was on my first order, the total
/> price for all my Islit supplies for 3 months is
/> $155.52 + $95 + $125 = $375.52, which =
/> $125.17 per month ($1,502.04 per year).

The $4130 donut hole, I may have to pay an
additional $605 once I've reached that level
of pharmacy purchases. I'm guessing the Dur-
able Medical Equipment Dexcom G6 supplies
won't count towards the donut hole, but I may
be wrong about that.

[AntiPro&T1.1DM]

_ wrote:

> CCS Medical charged me 1 penny

That's not the last bill you'll see from them. They bill Medicare and Medicare
says it will pay $X for the bill, usually much lower then the bill. Then CCS
will ask you to pay the difference $Y. The process may take 5-6 months to
get your final bill.

The 1 cent is just to check your bank account access. It ain't over yet.

[_]

On Saturday, February 27, 2021 at 9:21:48 AM UTC-6, AntiPro&T1.1DM wrote:

/> _ wrote:
/>

/> > CCS Medical charged me 1 penny

.> That's not the last bill you'll see from them. They bill Medicare and Medicare
.> says it will pay $X for the bill, usually much lower then the bill. Then CCS
.> will ask you to pay the difference $Y. The process may take 5-6 months to
.> get your final bill.
.>
.> The 1 cent is just to check your bank account access. It ain't over yet.

Interesting, Humana Pharmacy takes money out of my account
immediately, so it's mysterious why CCS Medical would take 5 to
6 months to bill me what I suppose minus 1 cent will be $155.51
and Humana Pharmacy bills me immediately.

Their only website, they have a place to pay a bill but they say I
owe them $0.00, and they provide no clue about it taking 5 to
6 months to charge me, and that $155.51, I was given that cost
over the phone, along with a lower cost of $98 by someone else,
but there is no record at their website regarding that.

I wonder if I could get delayed billing if I switch to using CCS Med-
ical for my insulin, insulin pump, test strips, and alcohol swabs. I
find this entire Medicare / CCS Medical / Humana Gold HMO pro-
cess, along with that Pharmacy donut hole, to be ... well, it reminds
me of the Texas Power Grid, not a pleasant reminder.

/~> . ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~
/~> .
/~> . INSULINITIS (ISLIT)
/~> .
/~> . New SUPERIOR clarifying name for near-
/~> . total to total loss of endogenous insulin
/~> . https://prohuman.net/pix2/new_superior_clarifying_name_is_INSULINITIS.jpg
/~> .
/~> . The overwhelming majority of Islit caused by
/~> . autoimmune attacks on pancreatic beta cells
/~> . (Insulitis Islit) but there are
/~> .
/~> . o 13 specific types of rapid onset Islit, a
/~> . rare condition (only present in < one-half
/~> . of 1% of Americans & in a much lower rate
/~> . in most of the world), when present is typ-
/~> . ically diagnosed at age under 30
/~> . (50% at age < 18, 20% at age 19 to 29)
/~> .
/~> . o 1 slow onset specific type, Latent Autoim-
/~> . mune Islit, frequency unknown but per a
/~> . recent report, misdiagnosed as Cellosis
/~> . (new clarifying name for type 2 diabetes)
/~> . almost 40% of the time due to its slow
/~> . onset and its occurrence typically at age
/~> . over 30
/~> .
/~> . Old outdated anachronistic name for Islit is
/~> . type 1 diabetes, confusing in that diabetes
/~> . without clarifier is often used to describe
/~> . this condition which is 1 of the 7 Disparate
/~> . High Glucose Conditions (DHGCs).
/~> .
/~> . That makes figuring out which DHGC is actu-
/~> . ally being referred to (and it can be any one,
/~> . or some, or all of them when the diabetes
/~> . or diabetic word is used without clarifier)
/~> . confusing / difficult:
/~> . https://prohuman.net/pix2/diabetesdiabeticguessinggame.jpg
/~> . https://prohuman.net/pix2/diabetesdiabeticconfusion.jpg
/~> . https://prohuman.net/pix2/diabetesdiabeticendingthemisunderstanding.jpg
/~> .
/~> . - - -
/~> .
/~> . Insulin / Insulin Pump / CGM I use
/~> .
/~> . Fiasp Ultra-Fast-Acting Insulin in a
/~> . tubeless Omnipod insulin pump catheter
/~> . placed into skin / pod with adhesive
/~> . stuck onto skin every 80 hours, control
/~> . via PDM (Personal Data Manager)
/~> . https://prohuman.net/pix2/Fiaspinsulin_tubelessOmnipodDASHinsulinpump.jpg
/~> .
/~> . Dexcom G6 CGM (continuous glucose monitor).
/~> . https://prohuman.net/pix2/Dexcom_G6_CGM.jpg
/~> .
/~> . ~~~ ~~~ ~~~ ~~~ ~~~ ~~~ ~~~

[AntiPro&T1.1DM]

_ wrote:

> not a pleasant reminder

I saw my Doctor last August. Got his bill this January. Suspect Medicare is
slower in the pandemic with office staff working from home.

Pandemic blues in Aransas Pa$$, TX. Must wait and see what happens.