I changed my insurance plan this year with United Health Care, so that my co-pays would go up a bit, and I’d have to use all in-network providers–with the upside that all durable medical goods would have a $0 co pay after I met my deductible.
I’m dealing with Advanced Diabetes Supply, which has generally been great to work with. But they told me while my dexcom sensors are paid 100 percent after the deductible has been met, it’ll cost me a $55 copay for my pods because “We are only able to bill the pharmacy side of your insurance benefits for your omnipods at this time. We are unable to bill the medical side of benefits due to reimbursement rates.”
I’d like to get the pods billed as durable medical goods. Is anybody doing that? And if so, who do you use? I’m on the phone with insurance right now to get some clarification on this, but thought I’d probably get better advice here
UHC is sort of crazy to deal with. I was using Edgepark and they gave up trying to get my pods for me, they just couldn’t get it approved by United.
The rep on the phone just now said they had to be billed as durable medical goods. But I’d need a new approval, which is daunting. They recommended using Byram, which I’ve heard mixed things about.
Since my deductible is $300, it might just be a wash. Sort of disappointing but predictable.
The first time I got Dexcom sensors from UHC, they made me go thru DME (which on my plan meant an extra $1500 deductible). Every order since has gone thru pharmacy. In July, when the new formulary was instituted, Byram told me that I would have to go thru DME - and get a new prior approval - but after pushing it, I got them to try to bill thru pharmacy, and that’s been good for now. All my pump supplies have only been approved thru pharmacy - including Pods, when I was using them.
I’m in the opposite boat. I have Cigna and mine are billed through medical as DME, of which I pay 20% after deductible. I’d much prefer they were billed through the pharmacy where it would only be a $60 copay every three months.
