Glutamic Acid Decarboxylase Autoantibodies
Aetna considers measurement of autoantibodies to GAD medically necessary for distinguishing type 1 from type 2 diabetes when the clinical history is ambiguous and the results of testing will influence patient management. Measurement of anti-GAD antibodies is also considered medically necessary in diagnosing stiff-person syndrome. Anti-GAD antibody measurement is considered experimental and investigational for predicting the onset of diabetes and for all other indications.
Continuous Glucose Monitoring Devices
Aetna considers the short-term diagnostic use of continuous glucose monitoring devices medically necessary for persons with diabetes who have either of the following problems in controlling blood glucose level, unresponsive to conventional insulin dose adjustment:
Aetna considers the short-term diagnostic use of continuous glucose monitoring devices medically necessary to diagnose primary islet cell hypertrophy or persistent hyperinsulinemic hypoglycemia of infancy in persons with symptoms suggestive of recurrent hypoglycemia.For short-term diagnostic use, no more than 2 continuous glucose monitoring periods are considered medically necessary within a 12-month period.
Aetna considers experimental and investigational the long-term use of continuous glucose monitors for individuals with type 1a glycogen storage disease, persons with type 2 diabetes not using intensive insulin regimens, nesidioblastosis , neonatal hypoglycemia, and for monitoring blood glucose in non-diabetic persons following gastric bypass surgery because there is insufficient evidence of the clinical benefits of this approach for these indications.
Welcome To Advanced Diabetes Supply
Our Customer Care team will take the time necessary to answer any questions you may have about your insurance coverage, guidelines, requirements, new products, how to use your new products and much more. Our goal is to provide you with the knowledge, products and services you need to help make managing your diabetes easier.
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Does Medicare Pay For Diabetic Supplies
Diabetes services and supplies are covered by Medicare Part B and Medicare Part D . You must have Part B to get services and supplies covered under Part B and you must be enrolled in a Medicare drug plan to get supplies covered under Part D. Part B covers glucose testing monitors and infusion pumps, as well as test strips, lancets, glucose sensors, therapeutic shoes or inserts, tubing, and insulin. People with diabetes will have to reach their annual deductible to receive this benefit and then they are responsible for 20% of the Medicare-approved amount .
Part D covers insulin, oral diabetes medication, syringes, needles, alcohol swabs, gauze, and inhaled insulin devices. People with part D coverage will be responsible for coinsurance or copayment, and they may also be responsible for a Part D deductible payment. In order to receive these benefits, you must get supplies from a pharmacy or supplier thats enrolled in Medicare. Youll have to pay the entire bill for any supplies from non-enrolled pharmacies or non-enrolled suppliers. For people with Medicare, at-home diabetes supply companies can often save them money.
Continuous Glucose Monitoring Following Gastric Bypass And For Nesidioblastosis
Hanaire et al stated that hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report showed that CGM can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-hr fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, CGM is a very useful tool revealing the episodes in free-living circumstances and can be used to monitor the treatment success. The findings of this single-case study need to be validated by well-designed studies.
UpToDate reviews on “Medical management of patients after bariatric surgery” and “Complications of bariatric surgery” do not mention the use of continuous glucose monitoring.
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Freestyle Libre Flash Glucose Monitoring System
The FreeStyle Libre Flash Glucose Monitoring System is the 1st continuous glucose monitoring system that can be used by diabetic patients to make diabetes treatment decisions without calibration using a blood sample from the fingertip that continuously measures and monitors glucose levels after a 12-hour start-up period, the FreeStyle Libre Flash Glucose Monitoring System can be worn for up to 10 days. Users can determine glucose levels by waving a dedicated, mobile reader above the sensor wire to determine if they are hyperglycemic or hypoglycemic, and how glucose levels are changing. On September 27, 2017, the Food and Drug Administration approved the FreeStyle Libre Flash Glucose Monitoring System for use in individuals 18 years of age and older with diabetes.
The FDA evaluated data from a clinical study of individuals aged 18 and older with diabetes, and reviewed the devices performance by comparing readings obtained by the FreeStyle Libre Glucose Monitoring System to those obtained by an established laboratory method used for analysis of blood glucose. Risks associated with use of the system may include hypoglycemia or hyperglycemia in cases where information provided by the device is inaccurate and used to make treatment decisions, as well as mild skin irritations around the insertion site. It does not provide real-time alerts or alarms in the absence of a user-initiated action .
Team Approach To Diabetes Care
OSF Diabetes Care offers a comprehensive team approach to provide you with additional resources to manage your diabetes.Our board-certified endocrinologists and certified diabetes educators work together with your primary care physician to provide you with the tools you need to control your diabetes and live a full, healthy life.
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Artificial Pancreas Device Systems
Aetna considers a continuous glucose monitor and insulin pump with a low glucose suspend feature an equally acceptable alternative to a standard insulin pump and continuous glucose monitor for medically necessary indications.Aetna considers a continuous glucose monitor and insulin pump with closed loop system an equally acceptable alternative to a standard insulin pump and continuous glucose monitor for medically necessary indications.
Insulin Pumps & Supplies
Insulin pumps are small devices that contain a cartridge of fast-acting insulin. A precise motor transports insulin from the cartridge into your body through a thin plastic tube. If you are using an insulin pump, its important to keep supplies such as rapid-acting insulin, infusion sets, reservoirs to hold the insulin, extra batteries, and an emergency supply of syringes in the unlikely event your pump stops working.
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Mobile Application Software For Self
The effectiveness of mobile phone applications in improving diabetes outcomes has not been established . In a systematic review of 22 trials evaluating mobile phone interventions for self-management , investigators observed a modest decrease in HbA1c levels over a median followup period of 6 months . Studies examining the long-term benefit of mobile phone applications in improving clinical outcomes in diabetes are necessary .
Artificial Pancreas Or Bi
An artificial pancreas is a closed-loop system with an insulin pump, real-time continuous glucose monitor and a small computing device to coordinate glucose sensing and insulin administration.
Closed-loop glucose management systems with a continuous glucose monitor and an insulin pump programmed with a computer algorithm that calculates insulin doses from the CGM readings and tells the pump to deliver or temporarily suspend or reduce insulin based upon specified thresholds of measured glucose levels.
The Biostator is a glucose-controlled insulin infusion system developed in the early 1980’s for use by a physician trained in the device. There are insufficient data in the published peer-reviewed medical literature documenting the safety and effectiveness of the Biostator. The Biostator is mainly used in research it is rarely used in clinical practice.
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Insulin Insulin Syringes And Insulin Pens
Your doctor may suggest you take insulin to keep your blood sugar levels from getting too high. It’s a hormone that an organ called the pancreas makes to help you use or store sugar in the foods you eat.
If you have type 1 diabetes, your pancreas has stopped making insulin. If you have type 2 diabetes, the organ makes insulin, but your body doesn’t use it right.
Your doctor may recommend one of several types of insulin:
- Rapid-acting
- Intermediate-acting
- Long-acting
Each works differently based on how long they take to start working, when they reach maximum strength, and how long they last.
There are a few strengths of insulin, but the most common is U-100 . You’ll need to inject insulin from one to four times a day, depending on what your doctor suggests.
You can do this with a syringe, which draws a dose of insulin from a bottle. Or you can use an insulin pen, which is either pre-filled or has an insertable cartridge. There is also a type of insulin that you inhale.
Blood Glucose Monitors With Integrated Lancing/blood Sample
Aetna considers blood glucose monitors with integrated lancing/blood sample medically necessary DME in persons with diabetes who meet either of the following criteria:
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Disposable Blood Glucose Monitors
The ReliOn NewTek has been cleared by the FDA for marketing under the 510 process for persons with diabetes when recommended by their physician. It includes a disposable meter containing 100 test strips plus control solution. The ReliOn NewTek received FDA 510 marketing clearance in 2003. According to the FDA 510 summary letter submitted by the manufacturer to the FDA, testing demonstrated that its performance was substantially equivalent to the Hypoguard Advance Blood Glucose Monitoring System.
Best For Pediatric Population: Insulet
Insulet
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Free trial period: you can try the device and return it within 30 days for no cost if you do not like it
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E-script option for physicians makes it easy and convenient
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Most of the cost is covered through a pharmacy, which can reduce the price
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A separate PDM device is used to communicate with the wireless pod. Some people do not like having to carry this around.
Omnipod is a tubeless, wearable, insulin-filled pod that is very popular in the pediatric population of children with type 1 diabetes because it is wireless and can be controlled easily by parents using a hand-held device called a PDM . Working with Omnipod is simple and convenient because physicians can prescribe supplies and pods electronically. And, people living with diabetes love that they are not locked into a four-year warranty with the Omnipod. You can try it and return it at no cost if you dont like it.
If you or your child use the Omnipod, it is often easier having your insulin pump supplies delivered to your home directly from the manufacturer, Insulet. To find out if you or your loved one are eligible for the Omnipod insulin pump management system, start by filling out a form on the company’s website. An Omnipod specialist will reach out to your insurance provider and give you a call back within three business days. According to the website, the Omnipod DASH Insulin Management System may be covered by your private pharmacy plan, Medicaid, or Medicare Part D.
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Financial Help For Diabetes Care
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Diabetes management is expensive. According to the American Diabetes Association , the average cost of health care for a person with diabetes is $16,752 a yearmore than twice the cost of health care for a person without diabetes.1
Many people who have diabetes need help paying for their care. You can find help through private or government health insurance, local programs, patient support groups, and medicine-assistance programs. You can also find ways to save money on diabetes medicines and supplies.
How We Chose The Best Diabetic Supply Companies
Choosing the best diabetic supply company depends mostly on what type of insurance you have. Because there are so many insurance policies out there, we decided the most effective way to scout the best diabetic supply companies was to go directly to the source the people who use them. We interviewed people living with diabetes, as well as clinicians who work in the field: Certified diabetes care and education specialists, nurses, doctors, and dietitians. We asked them who is the most reliable, courteous, trustworthy, on-the-cutting edge of technology, and knowledgeable.
We also learned that before deciding on a specific company, that it’s important to find out who your insurance has contracts with, which supplies you need, and how you can get them all conveniently to your home with little fuss. People living with diabetes who use insulin pumps told us that it is often easier to get their pump supplies delivered directly from the pump supplier. They also told us that if you need more general supplies, such as test strips, a glucose meter, lancets, and others, then a larger company such as Byramhealth or Edgepark may be right for you. Shop costs and discuss with your medical team which option is right for you or your loved one.
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What Health Plans Does Medicare Offer
Medicare has four parts:
- Part A, or hospital insurance, covers hospital stays, skilled nursing homes, hospice care, and some home health care. Part A has no premium for those who have paid enough Medicare taxes. Part A has a deductible, which is an amount you pay for your care each year before the plan begins to pay.
- Part B, or medical insurance, covers doctor visits, outpatient care, some home health care, medical equipment including insulin pumps, and some preventive services. You pay a monthly premium based on your income. After you pay the deductible each year, Part B pays 80 percent for most covered services, and you pay 20 percent.
- Part B covers the Medicare Diabetes Prevention Program for members with prediabetes. The MDPP provides healthy eating and physical activity training sessions and support over 12 months, which research shows can sharply lower diabetes risk.
Best Support For Medtronic Users: Medtronic
Medtronic
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Reliable and courteous support staff
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Shipments arrive in a timely manner
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Offers technical support for using their equipment
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Your insurance must have contracts with Medtronic to get this product
Medtronic is a medical device company and a global leading producer of diabetes products, servicing more than 250,000 people with diabetes. It is often referred to as the best supplier of Medtronic supplies due to its efficiency, 24-hour technical support, and clinical support from other people with diabetes. Medtronic’s product line includes insulin pumps, continuous glucose monitors, sensors, and blood glucose monitors, to name a few. It also has blood glucose uploading software called CareLink, a free, web-based program that collects information directly from your diabetes management system, such as a continuous glucose monitor. You can generate printable reports that can be used during your doctor’s visits or for your own personal use to manage blood sugar. This software comes with a support system.
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Diabetes Medical Alert Bracelet
If you’re in an emergency situation, a diabetes medical alert bracelet or necklace can help paramedics or doctors treat you when you can’t speak for yourself. Many people with diabetes have one, especially those who use insulin.
A medical alert bracelet can mention things such as:
- You take insulin
- Emergency contact name and phone number
Show Sources
American Diabetes Association: “Can Diabetes Pills Help Me?” “How Do Insulin Pumps Work?” “Checking for Keytones,” “Hypoglycemia,” “Insulin and Other Injectables,” “Insulin Basics,” “Insulin Pumps,” “Insulin Routines,” “Steps to Prevent or Delay Nerve Damage.”
Diabetes Forecast: “Lancing Devices.”
Glucose Meters For Persons With Visual Impairment
There are blood glucose monitoring systems designed especially for use by those with visual impairments. The monitors used in such systems are identical in terms of reliability and sensitivity to standard blood glucose monitors. They differ by having such features as voice synthesizers, automatic timers, and specially designed arrangements of supplies and materials to enable the visually impaired to use the equipment without assistance.
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Lasette Laser Blood Glucose Monitoring Device
Aetna considers the Lasette laser blood glucose monitoring device , which uses a laser instead of a lancet to perforate the skin to obtain a blood sample for glucose measurement, experimental and investigational. There is insufficient evidence in the peer- reviewed medical literature that laser skin perforation offers clinically significant advantages over standard lancets.
Best For Replacements: Dexcom
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Reliable continuous glucose monitor that is compatible with many insulin pumps
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Easy replacement forms can be filled out online
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Youll need to have other diabetes supplies delivered from a separate company. Dexcom delivers only Dexcom supplies.
Dexcom, a type of Continuous Glucose Monitor , is used to help you check your blood sugars, identify trends, and alert you if your levels are trending high or low. Dexcom provides great flexibility in the delivery of supplies. Simply filling out a form online can determine if you are eligible for the product. And, if you have pharmacy coverage through your insurance, you can get your supplies delivered directly from your pharmacy. If you dont have pharmacy coverage, you can continue to receive supplies from Dexcom or your insurance-designated distributor.
CGM systems like Dexcom take glucose measurements at regular intervals throughout the day and translate them into information to demonstrate trends. These readings are used to help manage diabetes. A Dexcom user told us that in the instance she has a faulty sensor, she deals directly with Dexcom and has no problem getting replacements sent directly to her quickly and easily.
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