Three months ago I was assured by Liberty Medical AND a in long conversation with Horizon BCBS of NJ that Omnipods were definitely covered. I called in a reorder to Liberty yesterday and was told “We have a note on your account that on Oct 6 Horizon told us they would not cover pods in the future”.
You would think that Horizon would have notified me, THEIR CUSTOMER, at the same time so I could make arrangements to get a covered pump, or switch back to MDI.
One weird thing is that Liberty does not supply ANY OTHER pump that would be covered by Horizon. So I have to find another supplier, if indeed Horizon would cover a pump, which is yet to be determined.
Has anyone had a different experience with Horizon in NJ? I am so tired of these insurance nightmares.
We have Horizon in NJ, specifically NJ Direct 15. We only started the Omnipod in August, but were told we pay 10% of all costs, until we hit something like $500 out of pocket costs and then everything is covered 100%. I can’t say for sure that this is correct, as Horizon has a history of charging us for things long after the fact, even things they’ve told us are covered. Maybe I better go check for sure!
Have you called Horizon BCBS yet? Can you appeal this? Do they in fact cover other pumps but not the Omnipod? I have Excellus BCBS in NY, they have never given me a problem with the Omnipod but denied paying for the Dexcom after several months of paying for it. I appealed and won.
I called and said I wanted to start an appeal. I was told I didn’t need to do anything further, but I put together a packet to mail to them. I sent a letter explaining why I felt the Dexcom was important to helping control my blood sugars, and included examples of low blood sugars when I needed help from my husband to recover, and how the Dexcom alerted me to impending lows so I could recover without outside help. I also included the OmniPod and Dexcom charts that showed blood sugars in the 40’s. And I included a statement from the hospital emergency room for an episode of low blood sugar.
I think your first step would be to call them so you know what your options are.
