Insurance Co. Denying my coverage of OmniPod Supplies

I have been on the OmniPod for over 2 years. I have Coventry Insurance through the school board that I work for. Coventry has just taken over Vista and is refusing to continue the coverage that I had with Vista for my OmniPod. They will only cover Medtronic or Animous. I was on Medtronic for 8 years prior to OmniPod and liked it but I LOVE the cordless OmniPod so much more!! After getting the run-around for 3 months, Coventry told me today that they are denying coverage for OmniPod. Insulet Corp. has been so helpful through the nonsense with Coventry and are still trying to get an outside vendor to get me coverage through my insurance company. I really don’t want to go back to a pump with a cord but I certainly can’t afford to pay for OmniPod supplies on my own. I’m so frustrated that I spent the better part of the afternoon in tears. :frowning: Has anyone else gone through this? Any advice or tips? Thanks.

I’m sorry to hear that. Have you spoken with your Endocrinologist’s office? When I was working on getting my OmniPod I had a lot of run around from the insurance company to make it happen and the Endo’s office helped me out a lot.

Coventry insurance is crazy, and different from state to state. I waited for a year, being told that there was a contract between coventry and insulet that would go into affect “next month”. That contract never happened. But, Insulet instead, worked with a diabetic supply company in my state (NE) that Coventry did cover. Sort of a back door to coverage.

Don’t give up! In some regions, Coventry members do get the pod, I will hope that for you too!

DONT QUIT!!! THIS KIND OF THING JUST MAKES ME CRAZY… and yes, I have been thorough this type of thing wih my “insurance” company. I found it indispensable to fight along with insulet, and my endo both!! Let them know what is happening, and ask for help! If you have more than one doctor, get them all involved! Back when this was hapening to me, I ultimately had an ARMY of doctors, education nurses, and ultimately LAWYERS Involved before my “Insurance” company saw the light…it came down to a telemarketing call I got from them (Anthem) asking me if I wanted to join their “Diabetes education” group, where one of their “Diabetes education nurses” would call me once a week to help monitor my control… When I got her number and MY CDN and I called her together and challenged the wisdom her company had with regard to control, w/in two days or so, Anthem’s position was magically changed. I hope you dont have to go through all this crap, but just to let you know it can be done with persistance! Good luck, Sunflowr, and PEACE

Thanks Everyone! I definitely am not giving up. I did let my Endo know when I saw her last week and she did say she would help me out. Insulet has been wonderful and seems to be going above and beyond on my behalf!! I did tell the insurance company that when I had a pump with a cord, it often got pulled out in the middle of the night and I’d wake up with high BS. I also said that as an “insurance” company I would think that would concern them as future complications would have to be paid for by them. They were completely uninterested! I didn’t think of mentioning that I am constantly being hugged and grabbed at by 7 year olds and the cord could easily be pulled out then too! Thanks Spooky! I do appreciate all of your replies, advice, encouragement so much!! Thank you! I will keep fighting this battle and get my doctor involved. I appreciate any and all input! :slight_smile:

Keep us posted, and if you dont mind, pls. keep us up to date on my site: join in and lets fight the “insurance” companies together! ( you can read why I am such a demon when it comes to these issues there on the site nothing for sale there, I promise!) I do have a bit of a chip on my shoulder, or more accurately, a bit of a “chunk” on my shouldrer!

I put up the fight…I am on a Medicare advantage plan. At first I was approved, After waiting for the ins co to pay my suppliers, 8 mos. later they said “sorry, we made a mistake, you are NOT covered”!
I am now paying out of pocket for Omni Pod. I have posted this before.
I am now gong to contact my govt. officials, possibly a lawyer as well …We’ve been away all summer.
If I was not on Medicare my ins would pay for this, because I’m on Medicare they will not…does this make any sense??

No, Dee, that makes NO sense to me! IN fact since I have Medicare (one year) they seem to be better at covering all my needs than Anthem BC/BS…just keep up the fight! good luck, and PEACE

Liberty billed them as “reservoirs” and got it through?

My daughter and I both have the Omnipod and our health insurance just changed to Healthamerica on July1st They said we have tp pay the first $4000 to meet our deductible to get our pods. My daughter has secondary insurance through Gateway in Pittsburgh. At first they told me they would pay up to the deducible which we found would be $1600 and my husbands work would cover to the $4000. Well I have been fighting this since June 29th!!! Gateway then denied coverage based on high A1cs… my doctor convinced their doc to give her a 3 month chance to lower her A1C and we got approval over 10 days ago> STILL NO PODS…they won’t tell me why they won’t ship. Some are saying they need the right code. We are OUT OF PODS and I am losing my mind with worry.

A denial BECAUSE of high A1C’s??? That is a new one! Wow, talk about backward thinking! Can your endo write them a letter convincing them that maybe you need the POD to get your A1C’s down!? I just hate insurance companies…I really do.

WOW!! Maybe your A1c’s are high BECAUSE you haven’t had your’ pods for 3 months! What is wrong with these companies??? Unreal!!

I got a call from LIberty today. Apparently my doctor called them. They are varifying my insurance information and said my order should be shipped within a few days!! Yay, although I will believe it when they arrive! I sure hope this gets resolved!

So this morning, I called the school board on-site Coventry representative. The woman I spoke to was great! She promised me she wouldn’t transfer me to anyone else and gave me her direct phone number to call anytime. In reviewing my notes, she found that it wasn’t Coventry denying my coverage, it was OmniPod that didn’t take Coventry(?) This didn’t sound right to me since Coventry flat out told me that they were denying my coverage of the pods. Anyway, she said she would get back to me after she looked more into it.
Well, this afternoon, I got a call from Liberty asking to verify my shipping, billing info and my insurance info and said that my pods would probably ship in a few days. She also wanted to know how often I change out the pods, so it sounds promising! Not sure if I should get excited yet but am hoping for the best!

After using the Omnipod system for almost two years, Anthem has denied covering my pods 9 considered investigational and not medically necessary… same for my Dexcom seven…am in the process of getting all the medical info neccessary to fight back…my best advice is to keep fighting…

I’m not on the pump yet but I use neighborhood for my supplies. I just got my first shippment yesterday and got 11 boxes of test strips and 8 boxes of lancets. My insurance wouldnt of paid for that but they did. Depending on where you live, they may have a location where you are. is their website. Customer service is very nice and they do work to get what you need.

Is Coventary related to Healthnet? I am trying to get Healthnet to cover it, but it has been a impossible thus far.

I have network commonwealth care insurance. They ap off at 100 test strips. But with the help of neighborhood, I was able to get 11 boxes which will help me achieve what I need to in order to get on the pump. If you have safety healthnet here in MA, its a pain in the butt to get them to cover anything. They arent insurance but they are a safety net to help those who are waiting for insurance here in MA. And they aren’t shy to say they aren’t insurance.

Liberty called me back today to tell me that I can not be covered through them…this sucks! Here we go again!!!

keep fighting. If your dr needs to write a medical necessity letter then do so. insurance companies need to understand that if we dont control our Diabetes they will be paying for more issues that can come out later on.