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Medicare and B12
#1
Anyone on medicare or medicare advantage plans or supplemental plans know if B12 shots are covered according to medicare guidelines?

Thx
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#2
Likely not, unless you have a provable deficiency that cannot be corrected with oral administration.
See Pernicious anemia (ICD10 code D51.0) and Intrinsic factor.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
I would rather not have shots and take it orally like I do with Vitamin D when necessary, however, it will not cover Vitamin D3 which is what is best for D deficiency so I just buy them at the health food store. At some point, I have to choose between what I can buy out of pocket and what I can't. I am probably jumping the gun anyway as my bloodwork results are not back yet.
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#4
I take a sublingual B12.

Yeah, I know what it's like to choose what meds to buy.
I had to compromise on my Beta Blocker as Metoprolol Succinate is as expensive as the brand name. So, I take Metoprolol Tartrate which is the immediate release version. I also reuse insulin needles because I will not pay $0.25 each for a $0.05 syringe.

I have been supplementing with D3 since 2012; and I'm still deficient on the 25-OH vit-D blood test.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
(05-21-2015, 03:20 PM)me50 Wrote: Anyone on medicare or medicare advantage plans or supplemental plans know if B12 shots are covered according to medicare guidelines?

Thx

As of April 2014, Medicare will not pay for vitamin B12 shot unless you have a lab proven deficiency. The shot was being used for other purposes that lacked proof of effectiveness. If you feel that this is what you need, then you will have to pay for it. It's the pits sometimes.
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#6
(05-21-2015, 04:59 PM)justMongo Wrote: I take a sublingual B12.

Yeah, I know what it's like to choose what meds to buy.
I had to compromise on my Beta Blocker as Metoprolol Succinate is as expensive as the brand name. So, I take Metoprolol Tartrate which is the immediate release version. I also reuse insulin needles because I will not pay $0.25 each for a $0.05 syringe.

I have been supplementing with D3 since 2012; and I'm still deficient on the 25-OH vit-D blood test.

I had to take metoprolol for a medical exam and it was free with my insurance (medicare advantage plan) and the doc tried to make me keep taking it for some unknown reason. I weaned myself off of it and my blood pressure is normal. Last blood draw my B12 was 12 I think and then the doc said it was back to normal but I will find next week after my blood draw tomorrow.

Vitamin D3 is the best for a Vitamin D deficiency but it seems like they would try to find out what is happening that makes you have that deficiency. I suppose it could be some of your meds like the metoprolol (there have been reports that metoprolol causes this deficiency or contributes to it I probably should say).

sometimes it is a catch 22
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#7
One thing that doesn't make sense to me about medicare is that it should be about preventative because that is less expensive than treating something such as diabetes, heart issues, etc.

That being said, I will never get why medicare will not cover nutritional counseling for a pre-diabetic before they are diabetic and the expense for insulin, etc. is more costly. Why not get the patient information that can help them not become a diabetic. It is a whole lot more cost effective and easier on the patient and the cost to the insurance is much less. Now, the patient may not stick with it but then that is their choice and a huge mistake.
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#8
(05-24-2015, 01:44 AM)me50 Wrote: medicare will not cover nutritional counseling for a pre-diabetic before they are diabetic and the expense for insulin, etc. is more costly.

Follow the money...doctors are trying to get control of non-prescription nutritional supplements. Pre-diabetic (I am one) is easy to control with diet and nutrition. No $ in it for them.

"Life is not measured by the number of breaths we take,
but by the moments that take our breath away.
"
Hillary Cooper
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#9
(05-24-2015, 01:44 AM)me50 Wrote: One thing that doesn't make sense to me about medicare is that it should be about preventative because that is less expensive than treating something such as diabetes, heart issues, etc.

That being said, I will never get why medicare will not cover nutritional counseling for a pre-diabetic before they are diabetic and the expense for insulin, etc. is more costly. Why not get the patient information that can help them not become a diabetic. It is a whole lot more cost effective and easier on the patient and the cost to the insurance is much less. Now, the patient may not stick with it but then that is their choice and a huge mistake.

Why does insurance (medicare) have to pay for everything? The information is already out there FOR FREE on the internet, through AARP, etc. and has been for 20 years. Many clinics offer classes to prediabetics (heck, my large clinic offers them monthly at 5 different locations and times). Same reason that quit-smoking programs aren't free. The information that these programs provide is already out there. The classes are just to hold your hand, so you pay for it. The fact is most people make no effort at change UNTIL they actually have a diabetes diagnosis. They know this from followup on patients who take the classes.

BTW, most type 2 diabetics start on metformin, not insulin. Insulin is only used right away for those who can't tolerate metformin or related meds, don't produce enough insulin or have kidney disease already.

My clinic is actually having more success with patients in the pre-diabetes classes. They stopped following the American Diabetes Assoc. dietary recommendations some time ago and explain a different program (closer to Weight Watchers). Only 15% go on to develop diabetes in 5 years instead of 30% or more.
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#10
(07-07-2015, 09:21 AM)Mosquitobait Wrote:
(05-24-2015, 01:44 AM)me50 Wrote: One thing that doesn't make sense to me about medicare is that it should be about preventative because that is less expensive than treating something such as diabetes, heart issues, etc.

That being said, I will never get why medicare will not cover nutritional counseling for a pre-diabetic before they are diabetic and the expense for insulin, etc. is more costly. Why not get the patient information that can help them not become a diabetic. It is a whole lot more cost effective and easier on the patient and the cost to the insurance is much less. Now, the patient may not stick with it but then that is their choice and a huge mistake.

Why does insurance (medicare) have to pay for everything? The information is already out there FOR FREE on the internet, through AARP, etc. and has been for 20 years. Many clinics offer classes to prediabetics (heck, my large clinic offers them monthly at 5 different locations and times). Same reason that quit-smoking programs aren't free. The information that these programs provide is already out there. The classes are just to hold your hand, so you pay for it. The fact is most people make no effort at change UNTIL they actually have a diabetes diagnosis. They know this from followup on patients who take the classes.

BTW, most type 2 diabetics start on metformin, not insulin. Insulin is only used right away for those who can't tolerate metformin or related meds, don't produce enough insulin or have kidney disease already.

My clinic is actually having more success with patients in the pre-diabetes classes. They stopped following the American Diabetes Assoc. dietary recommendations some time ago and explain a different program (closer to Weight Watchers). Only 15% go on to develop diabetes in 5 years instead of 30% or more.

I respectfully disagree with you but I am not going to argue with anyone about it but I will respectfully state my opinion.

These classes are not just to hold someone's hand but to teach them what types of food will affect their sugar levels, etc., what foods to avoid, what foods that they can eat as much of, what foods to avoid, how to substitute ingredients/foods with healthier choices, how much protein, fats, carbohydrates, etc. that they need to eat each day to maintain a stable sugar level so they do NOT become diabetic. I can tell you now, I would not trust information that is on the internet as being gospel. And, just like with SA, it is all about patient empowerment and to have that, it may require assistance. I would think it much wiser and money better spent to have an insurance company/medicare to cover this rather than later on covering lancets, strips, medication and/or insulin, hospitalizations, amputations, vision problems and a whole host of medical issues that diabetics face. As I said, to me, it is wiser to pay for preventative maintenance that to replace an engine later on due to not doing that. You may not get that but it is what it is. This is my opinion/story and I am sticking to it.

quit smoking programs are free in the state I live in. That is one thing they are smart about because they know the repercussions and cost of smoking to the smoker and those that are around smoking (like when you are walking in to the store and there are smokers outside....which in the state I live in is against the law unless they are 20 feet from the door).
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