I want a lawyer

I can’t deal with this medical paperwork anymore. I loose my ■■■■ over it. I get so angry. I need to hire someone to make the necessary phone calls on my behalf to get the RX’s written and filled. Trying to fill paperwork eats up my whole life. I need someone to facilitate these business transactions on my behalf. I will advise them. But, I don’t want to do this anymore. Who do I call?

It sounds like you don’t need a lawyer, but you need to move your healthcare to a facility with a patient services department. I am at the Joslin clinic, and my endo writes the Rx for everything I tell her I need and how much I need, and then patient services electronically files the Rx with all vendors I stipulate for my medicare part B and Part D requirements. Any screwups with either Drugs or DME, I just call patient services at the adult clinic and they take care of it, even cross border when I was ordering my insulin in Canada.

Joslin is an 80-90 mile drive for me but the extra drive time, from dealing with a local endo, is so worth it to get the best care and not have to deal with vendors.

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Oh my God, CJ. It sounds like a dream. Maybe I should start flying there once a year.

They wrote and filled a second prescription for Omnipod 5 pods this week. Is there something I don’t understand?

Like, I know that my traditional med device distributor WONT carry dash. It has something to do with the fact that dash changed the billing codes from nondurable medical to durable medical (or visa versa). That explanation doesn’t make total sense because Omnipod classic categorized the pods as nondurable (because they last three days) and the PDM was billed as durable.

Do pharmacies carry dash pods?

Loopers will know because they run on dash.
My friend in town got denied by insurance when she changed from classic to dash. She said the appeal was like a nightmare.

So, there’s something about the dash that might be different.
But, if the pharmacies don’t carry pods and the distributor wont do it, then Insulet should have set something up.

This makes no sense to me.

Insulet reached out on a different social media platform. They want me to call them. I think they can fix this!

Insulet might have done everything right. It could have been the pharmacy that screwed up this time. The pharmacy was a wreck. I waited in line for 45 min. It was like waiting for food rations during the Great War. The tech were so young and so confused, possibly a little scared of us all. No one in there was happy. The techs knew nothing and could do nothing of value. Could have been the first day on the job. I dunno. It might have been the pharmacy.

@mohe0001 I have had no problem with getting scripts written for anything I have asked for from my endo. Sometimes a mistake is made on quantity and I just e-mail saying it was written for this, can it be this instead. It was the same with my last endo too. The only time I had any issues was getting a new Omnipod PDM. But that had nothing to do with the endo, it was Omnipod saying my pharmacy should have them and my pharmacy saying no they don’t. I finally got Insulet to send me a new one.

Obviously some people have more issues with endos, we know that because people are always posting about it. A good endo and one that knows the ropes seems to be the key to things going easy.

Some pharmacies did carry the classic pods, but they have been discontinued by Insulet. But some, probably more specialized pharmacies, do carry Dash pods. Under my previous insurance, Omnipods were classed as DME and were shipped to me by a local pharmacy, but under Medicare the Classic pods and now Dash pods are classed as pharmacy and both have been provided to me by Optum. I think it’s insurance that decides to cover it under DME or Pharmacy because of their unique patch pump classing, but you still have to find a supplier.

I think your right about that.

I think that insulet is shipping the pods, through their distributor, to a specific 24 hour pharmacy. It’s not a good pharmacy, but I think they are doing that because they are 24 hours and they are always there to receive delivery from the distributor.

There’s definitely no prescription for dash pods in the walgreens computer system because I’ve gone 4 time to check and recheck. They don’t have it. They have the 5 and the classic POD RX. No dash.

I’ll call Insulet again and check the 24 hour walgreens again.

I think its at the UPS fulfillment center.

They asked for 2 addresses and they couldn’t say to where it would be delivered. So, I gave them my brothers homes address and then selected the 24 Walgreens from a list.

The PDM went to my brothers house. But, then where did the PODS go?

There’s a 3rd option - it was delivered to neither address and is sitting in UPS fulfillment. That’s where it is.

I haven’t been crediting the insurer as much as I should for these hang-ups. The Doc said directly (through phone messages passed from his nurse) that he can’t find a pharmacy that will take my insurance for Omnipod Dash.

A friend of mine (whos husband is a surgeon, so she has insider doctor help with Rx’s) got trapped in appeals with the insurance company for months when she tried to upgrade from Classic to Dash.

There’s something about Dash that breaks insurance. That problem translates to the Docs and the pharmacy.

One of the girls at my old distributor is a T1 and she called me specifically to discuss it at length. She was desperate and spending a lot of time trying to explain to insurers how to bill for dash. The insurers couldn’t understand the process (with the DME/non-DME changes) and they would just deny coverage.

Maybe I need a lawyer AND a private investigator to figure this out. I wish there was someone you could call who just figures this stuff out and explains it. They could call the insurers and the doctors and explain what the hang-ups were.

I spoke with insulet. They said it was shipped to the 24 hour Walgreens (like I originally thought), but that then it got shipped to a different walgreens (they don’t know which one, but they spoke with a pharmacist at the 24 hour walgreens).

I know that a script for Omnipod 5 was filled at a different Walgreens. I had them delete the two Omnipod 5 prescriptions in the computer so that people weren’t getting confused on Monday. Omnipod classic script was already deleted.

I know the feeling. Hang in there, you will love omnipod 5 once you get the hang of it! That is, if this is a new pump therapy for you

I got a promise that it will be filled today. I started making calls at 6am and by 11, I had somebody who could do it. I just needed to talk to the right small pharmacy and take some time off of work.


Holy cow! It only took you from 6 am to 11 am (not to mention all the other days and hours of time on the phone and otherwise - sorry for the sarcasm)! I think this is not just an issue specific to Omnipod users but an issue that strikes at the heart of our healthcare system itself.

I am right there with you mohe0001, I have spent years worth of time chasing down, researching, correcting, filing complaints (with state insurance commission) in order to get services and/or supplies. Contacting doctors, retrieving records, contacting insurance representatives, DME reps, back and forth, forth and back, with almost everyone pointing their fingers at the others! I think mohe0001 is quite capable of wading through the swamp that we call healthcare but many are either not ready to do that or cannot do so on their own.

Anywho, I agree with the general sentiment in your original post!

-(sick and tired) Steve

I will write to Walgreens and see if anything can be resolved - like, the problem identified and fixed. I believe they intend to carry it because the insurer says they are authorized to. Insulet says Walgreens carries it nationally. Walgreens used to carry Dash. I believe it got deleted out of a local database and is no longer visible to the pharmacist when they try to fill the Rx.

Here’s me writing to one of the State “consultants” for the small pharmacies and I think this is my final Perspective on this matter.

“Here’s the failing logic that is occurring in this human hamster under study. I think to myself, “How will I resolve all the problems that occur in the paperwork without a 24 hour pharmacy?” I want a pharmacy where I can sleep comfortably in their parking lot on a weeknight while I wait for the problems to be resolved by an emergency, on call 24 hour nurse. That feels like a necessary part of the prescription filling process. However, it recently occurs to me that MAYBE those problems would never exist in the first place if I was using a small, competent, concierge pharmacy. I find it likely that a competent pharmacy is probably something I have badly needed my whole life. Thanks for helping to prompt this shift in perspective. I ran this by my dad last night and he says he is REQUIRED to fill at CVS because of his plan. He’s in a much worse position than I.”

You get a different level of service from small pharmacies. They are not open 24 hours, but they are competent. It’s unfortunate that so many of them have been put out of business. I’ve been doing this wrong my whole life.

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They filled the wrong Rx again. Fortunately, I looked inside the bag before I gave them $850.

This is one of those many threads which have persuaded me to stay on MDI.

@mohe0001 , I don’t think a lawyer and a PI will be sufficient . I think you need a conjurer , or a witch doctor, or whatever they call them in your part of town.

I really thought about this. I think that in order for a lawyer to have any effect, first I would need a lawyer who understood how healthcare works and that would be difficult. Then I would need to sue every involved stakeholder in order to determine who is responsible for this mess. I would have to sue all of these players every time something like this happened. Who’s go the time or money for that?

I have implemented another strategy that goes around the clinic completely. I think that it may work.

Success!!! I can’t explain how multiple backchannels of prescription filling mechanisms succeeded, but they succeeded so well that I turned the radio full blast, hit the gas, and fled from the pharmacy. I can’t say who screwed up in this transaction, but I made off like a diabetes criminal. I paid $300 for a 3 months prescription. The previous quote was $850 for a 6 week supply. It was kinda cinematic the way this new uncharted Walgreens appeared over the hill thru the fog. When I walked into the pharmacy, the pharmacist stopped what he was doing, walked over and said, “How do I know you?” I replied with a smile, “Omnipod Dash.” Though we had never met and I had never entered this particular Walgreens, we had heard about one another. I knew his name and he knew mine.

Now I dance!!!

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So happy to hear of your success! I am a retired lawyer and would not have recommended someoned on my profession. Perhaps a bookkeeper or paying a teen child if you have one to distance yourself from the horror of it all.

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Re-upping authorizations at start of year slows all paperwork down whether its at the doc or the pharmacy or the insurance company.

This delay often lasts through all of January.

The endo practice I’ve been going to for past 7 years is going out of business and now I have less than 30 days to find a new doc and get new prescriptions. All the local endos are quoting first upcoming appointments 4+ months out. Ugh!

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That’s a good point.

Start sooner than later, Tim12. We have had a lot of endo turnover since covid. As soon as I would get one, I would have 1 appointment, and then need to start looking for another endo because they were all getting offered better (sometimes pretty prestigious) jobs. I was seeing the best of the best back then because I had some really good, long term endos who gave good recommendations.

Since covid, its been tough. That’s why I started seeing a primary care. I thought I would give the system time to “settle down,” and then shop for an endo. He was fine until this fiasco. He was in over his head with this one. There were too many bugs in too many places for him to sort out.

Its prob time for me to find myself an endo, too. I was thinking that since Marie mentioned it. Hopefully we can. I think the labor market has stabilized.

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