Anyone fight BCBS for coverage?

Our insurance just changed from HAP to BCBS. Been on the Omnipod for 3 months (under HAP) and love it. Now BCBS (which follows Medicare guidelines) is denying coverage for the Omnipod, said it’s considered disposable. They’ll cover Animas and Medtronic.
Question is, has anyone fought BCBS or other ins. companies and won? How did you do it, what info did you provide, what arguments did you use?
Help!! I don’t want to loose my Omni!

After a year of miscommunication with my insurance co. and Insulet I discovered my ins. co. only paid 50% of my durable medical eqipment which was quoted at 100% at the time I started it. Insulet claimed it was the insurance company’s error and vice versa. I called a lawyer and they wouldn’t touch it because they knew I couldn’t win. Long story short… I worked out a payment program with Insulet which fits my budget. They are excellent at working with you because they DO NOT want to lose you as a customer. Call the billing department and see if you could work out a deal with them. Good Luck.

Hey Barb, I have been on the OmniPod since May of this year, it seems like I remember some talk about that, I too have Blue Cross Blue Shield, but it is actually a NECA/IBEW self insured plan managed by BCBS, I had to have my docotor write a letter of medical necessity and then the OmniPod or actually Insulet people got involved and they worked it out with the insurance provider, it seems funny that they say that it is considered disposable, I dunked my PDM in a cooler this summer, at $500.00 for a replacement the people at Insulet obviously don’t think that it is disposable. It all sounds like symantics, I think, and I know that’s not worth alot, that if you can convince them that the PDM is a durable medical device and the pods are exactly the same as an infusion set with an Animas or Medtronic with the minor difference that the electromechanical portion of the Pod is shifted to the infusion site as opposed to being internal with the other guys, a portion of both systems is disposable, like tires on a car, just because you put more expensive tires on your car does not all of a sudden make the whole car disposable when it’s time to change them out…Good Luck and don’t take no for an answer. Take care. John D. Carlton

They’re also are not covering my CGM which I’ve been on 4 months and REALLY don’t want to lose that baby! I started another post asking if anyone has fought that and won.

Thanks John,
I know all the arguments make sense to us but I think all they care about is the bottom line. How much can we make off this and they make more off of the other pumps, simple. I am going to figure out the yearly costs for each and see how it compares. I think their thoughts are that the pod is disposable and each pod costs more than a simple infusion set, and they probably figure in the wasted insulin (which I don’t do!) I am really torn between moving on to a “tubed” (yuk) pump and trying to fight or just go back onto pens and fight.
I spoke with an animas rep today and she said that the Accu-Chek Spirit will become one unit soon; glucometer, PDM and will send boluses wirelessly. I was surprised to find it currently has 3 devices to drag around!

I have a medicare advantage plan by… United Health Care,.which follows medicare guidlines .ARE YOU ON MEDICARE? My pump ( the Omni Pod, is not covered). I have talked to other insurance agents…same deal, If medicare won’t cover it, they won’t either. IF YOU FIND A COMPANY THAT DOES, I WOULD LOVE TO KNOW WHO IT IS…
Long story, but the short of it, first I was told I was covered, so I started, then told. “sorry, we made a mistake”, I now pay out of pocket for the pods. UHC would cover this pump if I was not on medicare. Does that make sense.??. Insulet said they did a presentation to Medicare and are waiting for an answer (so they said).
My plan would cover any of the other tubed pumps I’ve been told, but I don’t want them…
WHAT COMPANY IS HAP?

No, I’m not on medicare, my husband is salaried with GM. HAP is “Health Alliance Plan” and was fantastic, got the Omni with no blood work or discussion. Were covered for several years. The first of Jan. GM dropped HAP and we had no choice but to switch. Our BCBS follows the medicare rules, so neither the CGM or Omnipod are covered. How did you hear about Insulet doing a presentation? The insurance companies are really controlled by the employer. Our HAP plan can be completely different from another plan. It all depends on what kind of deal is struck and how much the employer is willing to pick up.

If you are not on Medicare I don’t see why you should be affected by what medicare covers . That is baloney! Your ins co. is putting you off.
I would definitely appeal/fight . …
Good luck!

The BCBS we’re on basically follows medicare guidelines.