This am got a call from Edgepark saying my DELAYED shipment of PODS wasn't coming as my Insurance denied the claim. This is after assuming that the order confirmed for a June 6 delivery was as usual (past 2 months). I had called Edgepark last night and the rep was sorry and couldn't understand why I hadn't received my shipment, so she said she would authorize an overnight box. Now who is correct? I contacted my Omnipod rep, Carla and she said that this issue is occurring especially with Edgepark and was covered on this am's conference call: she will report this to the bosses. She said to call Insulet and they are sending me 3 pods to carry me over until the problem is resolved. I call my insurance company and they resolved it by going to another DME, OneSource who is sending me a box and they think it will have NO copay. I wait, fingers crossed and gave my next caller from Edgepark the full benefit of my appraisal of their service.
Suzanne
ps sorry if this is a repeat message as my laptop is out to lunch and has low blood sugar
Omnipod told me that the old pods are on back order! I am switching to one touch ping! I can not take the terrible customer service I have been receiving!
A significant fraction of the frustration with diabetes comes from the headaches of continuous fighting with insurers and suppliers. And it never stops. Just when you think it is all figured out, they change the rules.....
This whole thing is the reason I pushed so hard for them to send me my PDM before my warranty was up.
Medco/Express scripts had NO supply problems POD wise (i figured out the code to the new pods and scored 4 boxes 3 weeks ago) Just had to wait for Insulet to deem me worthy of a PDM after calling every day and doing BBB and Attorney General complaints.
In the end..new PDM will be here thursday, but its been a struggle to say the least
My insurance, Anthem BCBS that I've had since January 1 of this year, has denied every shipment of pods I have recieved from Edgepark. They are denied because they are deemed not medically necessary, paperwork is requested and provided and the claims are ultimately approved about 2 months later. Edgepark told me that they do have this issue quite frequently. When I ordered the new PDM out of pocket, I needed the new pods obviously and ordered them from Edgepark. They were initially holding them up since the previous order (of old pods) still wasn't approved but I had them release the order anyway. I hope you get it straightened out.
We had one pre-tax flex plan carrier whose people thought we were trying to get reimbursed for an Ipod music player to use while exercising.(which is not allowed).
None of the processors had ever heard of Omnipod. I would routinely copy the Product Description from the manual and write "INSULIN PUMP" in big letters on the invoice with every submission because it never went to the same person twice. And still they would deny the claim for reimbursement until I called. At the end of the year, when I had everyone on their staff educated and trained, my husband's company switched insurance carriers.
Update: Well, OneSource (my Diabetes Supplies carrier) came through and I now have a 10 pac of pods. I am waiting to see if I am paying a copay or my Advantage plan covers that as well. The theory is that, since Medicare Part B says equipment is authorized, it is an 80/20 share, which I was paying for pods from Edgepark. OneSource is unfamiliar to the Pod and I educated my rep on what it was, how wonderful, etc. She sent it out with no copay under the assumption that my 'Advantage' would cover the copay. I will post if I get a bill or not ..
