I will soon be going on Medicare as I’m almost 65. I’ve been on the pod since 12-15-08. In talking with Insulet this morning in regard to re-ordering the pods, it came up in the discussion that not only have I changed Doctors since my last re-order, but I’ve also changed insurance plans (thanks to my husband’s employer).
Since the ‘new insurance’ is out of network if I want to continue using the OmniPod I will have to pay $365 for a box of 10 pods. I was also told that Medicare does not cover any durable medical equipment like the OmniPod. Because of the cost I will probably be forced back to MDI. Can anyone tell me how this is done? Do I take my TDD (total daily dose) and divide it in half to figure the two basal injections (which will probably be Lantus) and then try to figure out my insulin to carb ratios for each meal?
Needless to say I am really upset over all of this.
Mayumi
I’m sorry to hear that you may have to move away from the pods! That’s never good news.
My TDD is not a 50/50 split between basal/bolus (although a lot of literature suggests that). You can access how much your basal and bolus are by going to: “My Records” --> “Insulin delivery” --> and then scrolling through using the arrows to see your day to day. That will give you a % breakdown and a total unit breakdown. The basal should be relatively the same each day (unless you set lots of temp basals). This will give you an estimate of how much Lantus you should take. And that number could either by used as the once daily shot, or could be split in 2 parts if you’re going to take Lantus as a twice a day item.
Then your insulin:carb ratio should stay the same as what you’re already using…so whatever you’ve got programmed into your PDM will work, as long as it’s been giving you the desired results. That can be found with “Setting” --> “System Setup” --> “Bolus/Basal/calcs” --> “Ratios/Factors/Targets” --> “IC ratio”.
Hope that helps you some!
I’m sorry and furious that Medicare doesn’t cover the costs of medical durable equipment. That’s very frightening if someone needs this equipment to survive and can’t afford it. But that’s another discussion.
I think you need to talk to your doctor and work out your ratio insulin numbers with him/her. I was on injections for 4 years before going on the OmniPod pump and my doctor and his staff figured out all those numbers for me.
Sorry for what you’re going through, it’s hard enough having Diabetes coupled with all the medical expense. Good luck.
I wouldn’t try to figure this out on your own… is going back to the doctor to have them figure it out for you not an option?
Called the Endocrinologist this morning for an appointment and the first opening he had is July 1st. I could just cry.
I don’t know if this will help for now but I get my Omnipods through a medical supplier (I use CCS Medical but I know there are many more out there) because getting them directly from Omnipod is considered out of network but CCS is still in network. I would call both your insurance company to see if any medical supply companies are in-network and the Omnipod Insurance people to see if they can help you with this. I’m not sure what to say in regards to Medicare. Good luck!
For help with Medicare… there are 2 ways to get a pump…
- You must have a ugly A1c > 7… OR (yes higher than 7)
- You must be currently on a pump and test at least 4+ times a day AND see an endo every 3 months (if i read it correctly)…And yes they will want copies of your logbook
Thought it might be similar to medicaid and I was close to right…
heres the link
http://www.insulin-pumpers.org/howto/medicare.shtml
(thanks to the people at Insulin Pumpers for the information)
Unfortunately pods are out of the question last time I looked into this issue…
Are you sure Medicare wont conver the pods? I’m on Medicare and my strps have been covered 100%. I guess it depends on the Medicare plan you are on…I’m on Medicare A. I would call Medicare and explain that this has been your therapy for years and see if your endo will help.
This sounds liek a bummer. Good Luck, and keep us postee!
STEVE…
Unfortunately, I pay for my pods out of pocket…Medicare will NOT cover the omni pod. They cover other pumps but not this one. Fair?? most definietly not!
Dee - It really isn’t fair, I agree with you. Don’t you feel extra anxious if you have a pod failure because that is money out of your pocket if they tell you they will ship it with your next order? I’m never quite sure if they’ve kept accurate records of the pods that have failed for me.
Mayumi,
It may not be an issue of switching to MDI. There may be a different brand of pump that is considered “in network” by his insurance or allowable by medicare. I would look into that first!
Hope this helps,
Carolyn
Dee -
NO, doesnt seem fair at all! I would like to hear their reasoning…have you spoken with someone? What was their reasoning? I would think that Medicare would be more understanding. and reasonable…I have really been impressed everytime I deal with them. (which has been MANY times…given my pockmarked medical past, diabetes (of course), stroke, brain hemmhorage, retinopathy, many eye surgeries, etc.) Peace and good luck!
Like Rebecca I have to use a medical supplier to receive my omnipods. I use Edge Park and Insulet told me that they were the provider that was in network for me. I would call Insulet back and talk to someone to see if you can go with a medical supply company to get your omnipods. I hate to hear that about Medicare you would think they would cover a medical device that you are already using and familiar with.
Have you checked to see if a part “c” premium would cover your POD’s if none of the part D options work?
My hubby and I are meeting with an insurance agent on Monday morning to decide on part “F” and part “D”. I’m just so tired of this whole process. It is almost like Medicare would rather pay for an amputation than to pay for equipment and technology that might help me to be more healthy. Sigh…
I KNOW>…isnt that the TRUTH!!! INsurance companies, for Gods Sake! MIne offers a “free diabetes care service” we encourage you to join because you are a type one and we know whats best for you." Then, interestingly, when I try to buy test strips more often then not they do not approve b/c I am buying too many!!!
we know whats best for you."
That statement is a bunch of baloney and it probably came from someone who isn’t even diabetic. No one knows what is best for you except you and maybe your doctor (if you have a good one). I test anywhere from 10-15 times a day because I was on a steroid medicine that drove my BG way higher than normal. And like you, ‘they’ didn’t think I needed to be testing more than two or three times a day and never mind that I’m also type 1.
I agree with evreything you say…and I have said that very same thing to the telemarketers from my insurance company that call e at least once a week, “Nobody knows about my condition better than I do” The response is always “So, you dont need any help with this condition? I dont believe that! Sir, we have diabetes educated nurses to man our phones 24/7 to help you out if anything goes wrong. YOur health is our primary concern.” And, of course, I do. Actually, we all do. But, I have to also believe that insurance companies are the very LAST place to go for good advice and help! And, again, When I tell them I test on average 8 times a day they say “that is WAaaaaaaaaaaay too many times, a diabetic in good control should be testing 4 to 5 times a day, and that is how we set up our reimbursement system.” “Oh, thanks.”"
I’m glad you are seeing an agent - none of us are insurance experts and medicare just does’nt seem to work the way I always thought it did. Lots of the system seems to be focused on the care of “third party” providers, and not real patient health care. I lean on my endro group for help with the paperwork, as nine times out of ten they are the ones who end up having to file additional paperwork if justification is needed for say, more than eight BG sticks a day. Those folks are motivated to help me stay in range so they are the first ones I go to with insurance problems. Getting with the manufacturer can sometimes help. You can also go to the medicare.gov site to learn some medicare rules and terminology so you have a better idea of what to ask for from your insurance agent or diabetes team. Good luck and try to stay positive.
Thanks for the positive suggestions, I appreciate them. It is so easy to become discouraged and give up. I’ve had a chronic ear infection (Yes, at my age) for the past 10 months and now it is looking like I’ve finally found a doctor who can treat it successfully without surgery. Medicare is intimidating to say the least and hopefully our meeting with the insurance agent will go well. I will keep in touch as I’ve learned so much from TuDiabetes and the kind people here. 