How many weeks has this been now? Today I found out that Insulet is a non-preferred provider through my medical group, not my insurance! I found out who the preferred provider medical supply of the Omnipod are acceptable through my medical group and am asking my doctor to request authorization through that supplier as medically necessary.
Does this seem like what has happened to others? I'm getting very frustrated in my quest. Insulet has had me calling Blue Shield and asking all sorts of questions Blue Shield had no way of understanding.
Even though Blue Shield will cover me 100%, though they say, I am assuming it is from a preferred medical supply provider.
I have BCBS as well and they really had no idea on what all was covered. It is through another medical supply company. My son is covered 70% with BCBS so we did have some out of pocket expenses and still do have them. Do you have a local Omnipod rep? Call your rep. They should have an Omnipod person that will put it all through your insurance company and endo and then should call you with your coverage. We had an answer in about 2 days what was covered. We are on the Federal BCBS program so might be different than yours. Good luck. My son totally loves his Omnipod.
I have Anthem BCBS and ran into the same problem.... Insulet itself is not an authorized provider (though they are for other BC/BS plans!) They had me get the Omnipod system through a distributor. And the pods I have to get filled via my pharmacy plan (CVS/Caremark).
Thanks you guys. Once insulet heard they were non-preferred they kind of dropped me!
Try naborhood diabetie s that's my supplier
At least you can easily change doctors...
Yes, correct - before I changed insurers at the start of this year I was with bcBS and they did, indeed, drop Insulet at some point and require that supplies go via a third party.
I'm back with Insulet now because I'm with ODS (moda); the Oregon Dental Service (go figure, I pay for my own teeth :-)
I have no idea what a "medical group" is; does that mean "insurance policy"? I know the same insurers offer different policies. Anyway, it doesn't matter; there was no choice but to march lock-step, feet and arms swinging high to the appointed official distributor.
A medical group is the group of doctors, my network
I have to admit I don't understand. I think my insurer uses the same terms too, but it's one of the things I find incomprehensible (in my defence, I didn't grow up in the US, some of the culture still eludes me!)
This happened to me about a year ago. I have bcbs of California, but live in Nebraska. I wasn't even notified, I found out when I got an outrageous bill from Insulet. I now have to go through a local Diabetes Center where I live. Good luck!
Me too, and I was born here!
Hi Antonia. Thanks, and does the center bill your insurance?
yes. They tell me before hand what my portion is, I go pick it up and they deal with insulet.
I have Anthem and get pods and PDM through Edgepark Medical.
Hello everyone: I have followed this discussion because I recently had to change insurance companies, due to the decision of my employer . I am retired and must pay a cobra type insurance plan. My new insurance company, Cigna, not only requires a large co-pay for pods (Durable MEdical equip) $500.00 , but requires that I pay ALL of my out of pocket allowance before they will cover the Omni pod at 100 percent. This comes to 1500.00, and is now a hardship for me in retirement . Based on other discussions, I asked Omni pod if the pods could be covered under pharmacy or disposable category, but they absolutely refused. FDA combines the pod and PDM as Durable medical. It looks like I may have to go off pod therapy completely if I stay with Cigna. The customer service folks could not explain why disposable pods are classified as DM ...but admitted "that is the way that it is" . Any advice out there? I think I may have hit the wall this time.
You don't have to use COBRA:
When I retired (2001) COBRA was ridiculously expensive so I simply used a private policy.
For certain you will have to cover the deductible. Because of that look at the 'gold' policies, or platinum if you are in one of the places where they exist (not here :-(
At present I'm paying the cost of the insurance plus the $1500 deductible, then the pods get covered. Insulin and strips get treated as prescriptions (there is no logic to this), so I'm still paying some, apparently decreasing amount, for those - $60/month or less. Total is about $7500/year. My OOP max means that I can never pay more than $11,500/year, which is enormously much better than it was last year.
If you are having problems meeting the deductible you're going to get a refundable tax credit too, assuming you go for a marketplace plan; reduce the total you calculate by that amount. The exchange should figure that in to your premiums.
I went hell with insurances for omnipod... it worked for a while although I still had to pay in part for the pods. I'll now be starting on the Tandem t:slim pump because Medicare doesn't cover OmniPod at ALL...I tried everything. They consider it a "luxury". Go figure.
Since I have Tri-Care for Life (Medicare first then Tri-Care second) Medicare won’t touch it but Tri-care will cover about 70% so it cost me $525 every 3 mos but it is worth it even that I am on a fixed income.
I'll be starting on the Tandem (T:slim) next week which is covered 100% by Medicare. It's not tubeless but it's better than paying so much money every month. I'm looking forward to it.