LivingMy Story

Painful Medicare Journey to get GGM/Pump Coverage

Those who want ‘Medicare for All’ are really misguided when it comes to obtaining advanced diabetes technology

Tom Linn, retired Colorado attorney tells his story

We spoke with Tom Linn an attorney in Colorado who was diagnosed with T1D at age 69, 3 years ago. 

This is his story.

“My symptoms were classic yet I was first diagnosed as Type 2. My blood glucose never lowered and after 10 days with no improvement, my primary care doctor gave me a pile of syringes and a vial of Humalog and sent me home with few instructions. 

I quickly realized my primary care doctor was not very knowledgeable of T1D and despite the often-disliked Medicare insurance I had, I was fortunate to find an endocrinologist who had studied at the world-renowned T1D Barbara Davis Center in Denver.  She got the diagnosis right and introduced me to insulin pens, then a pump and then a CGM and, importantly, how to live with T1D. Each of these steps, taken over several months were game-changers enabling lower A1c, fewer blood glucose excursions and, overall, resulting in a better life for me and those around me

As noted, I am on Medicare and  I had to fight to get an OmniPod pump. I wanted the Omnipod because I have an active outdoor life hiking, skiing, fishing, and scuba diving.  Its waterproof feature is terrific.

The OmniPod was clearly authorized under Medicare Part D but CMS would not approve my request.  I paid for the Omnipod on my own for 18 months until it was finally supplied under Part D [the Medicare drug benefit].

I am now in the same fight all over again with CMS to upgrade to a Dexcom G6 which is much easier to attach and is clearly a better CGM compared to my G5 provided under Medicare. 

Those who want “Medicare for All” are, at best, ill-informed.

I am soon to experience yet another game-changer.  With the help of other users, I will build a RileyLink (website) to create my own artificial pancreas. I saw a demonstration at a conference recently so I am confident that I will soon, once again, improve my life with the use of a device that can predict and intercept the inevitable excursions that happen with this disease. This will be a giant leap which will hopefully reduce the occurrence of potentially life-threatening events.

I believe my contraction of Type 1 Diabetes has something to do with herpes simplex 1, the virus responsible for cold sores. The reason for my conclusion is that before I got sick with T1D, I would have 4 or more cold sore outbreaks each year in the same place, of the same or similar duration and with consistent symptoms.  Since getting sick I have had no outbreaks.”

Martin is the Founder of SelfRx Media and editor-in-chief of Insulin Nation. He's a passionate about sharing knowledge with those affected by Diabetes.

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