Blue Cross Blue Shield issues and Omnipod in Minnesota

I replaced my Cozmo pump (or I am trying to replace it) with the Omnipod, but Blue Cross Blue Shield Minnesota is being problematic. My plan (BCBS Advantage) is supposed to use only in-network providers–ones in the state of Minnesota. They have said they will not cover new pods. Anybody have any similar situations which they were able to address successfully?

If all I am allowed to purchase is Minnesota-based goods, I am stuck with Medtronic. I had extremely bad luck with them with my first pump, and I will not go back to them. I would rather return to MDI.

You can usually work to order your supplies from some in-network supplies.

I know that I needed to do that with my Cozmo. Instead of ordering my pump from Cozmo, I ordered it from an in-network suppliers.

Can you get the full list of in-network suppliers and see if any of them carry the OmniPod?

Do you happen to know if the recently changed the policy? I was on BCBS (not sure which plan) and at that time they allowed pumps from the manufacturer if not available in-network. Like Kristen said there probably is a supplier in the Twin Cities if not Mankato. I haven’t had that insurance for 6-7 years or so, it may have changed. And I am not sure which plan I had.

Good luck!

There was a change in 2005. I am waiting for a phone call, now, from BCBS. After calling them (for the fourth time), and informing them that I had received different information each time I had called, they finally took the number of the Insulet problem solver I had been talking to. I expect an answer tomorrow morning.

If I cannot order directly from Insulet, I will ask for the name of suppliers in Minnesota, and try to track down a source.

Confirm that they will cover CPT A9274.

Your supplier does not have to be located in Minnesota, they only have to be in-network or in-contract with BCBS Minnesota. Insulet should have a distribution center or distributor in that or around that State that is contracted under BCBS MN, I would be getting them to help instead of trying to track someone down yourself.

Thanks . . . I will contact Insulet and BCBS tomorrow.

An update–

Insulet will send me a three-month supply of pods, even though issues with BCBS have not been resolved. Each call to BCBS gave me new issues, new problems. There are no Minnesota suppliers for pods, according to Insulet.

Good luck, John! 5 years ago I would have been surprised by this fight. Unforunately recent court rulings make it easier for insurance companies to deni coverage. I have to believe that there is another Minnesotan out there on this insurance using the pod.

On the other hand, Insulet has an interest in getting this approval through. If my case gets approved, they will have a process that can be applied to others.

True enough, and a state of over 3 million (old number from about 1990) should pose an opportunity.

Empire Blue Cross Blue Shield initially denied the purchase of the monthly supplies (pods). I appealed that decision and WON! Insulet rep did all the legwork in discussion with my employer who convinced Empire BCBS.

Thanks for the encouragement–this is the stage that I am in right now. Insulet has shipped the pods in the meantime, telling me that I will not have to cover the full cost. My frustration continues to be with BCBS, who gives a different story every time I call (and Insulet tells me that they, too, get entirely different stories). The contract is so complex that the staff at BCBS apparently are not fully informed about all the details!

It has been a bit longer now. Blue Cross/Blue Shield Minnesota will allow me to purchase the pods from Edgepark Medical (I also get my Navigator sensors from Edgepark). I don’t have all the details worked out, yet, but Insulet was good enough to send me enough pods to tide me over.

I had nothing but trouble with BCBS after my employer switched from UHC - the plan I was on was supposed to be identical to the UHC plan, but they denied all coverage on CGMS systems no matter what - even for people with seizure issues, etc.

I’ve left that employer now and am at a new one with UHC, and will never take another job at a company with BCBS “coverage” if I can help it.