We have blue cross blue shield and although initially denied we did get approval.However, more disturbing is that now Omnipod has told us that they did not reach an agreement with Blue Cross Blue Shield and therefore to continue with the Ominpod, we have to pay.
Despite the fact that I recently spent about 3 afternoons on the phone with Omnipod to check that our insurance was going to cover it and I was assured it was, they neglected to inform us of this.
More disappointing is that we only found out about it when we called to order more pumps.
My questions are;
is Ominpod going out of business
2)If they can’t reach an agreement with BCBS then what does that say for the future of Ominpod ?
What you have to understand is that there is not a single BCBS policy regarding coverage for a particular treatment - it depends on the type of plan that you have, and each plan has been individually negotiated. I see lots of people here and on the insulinpumpers.org mailing list that seem to assume all policies from the same insurance company provide the same coverage - they do not.
So I would not assume just because your particular policy is hiving coverage problems that it means all BCBS customers will face the same issue. I’m on the BCBS federal employee PPO plan and will be placing a pod order within a week or so, so we’ll have another data point once I do…
I didn’t get a pump denial…in fact they covered it 100%
but I went to the pharmacy today to pick up my strip perscription and insurance wouldn’t cover them.
make sure you’re very understanding about what they will or will not cover…
My insurance coverage for the Freestyle strip the Omnipod uses is $45 a month, which is a lot more than the $10 I would pay if I used a test strip that was on my insurance companies formulary list. However, Abbott the maker of freestyle offers a Freestyle Promise program. You can get a free membership by calling 1-866-246-2683. They will send you a membership card and pay up to $50 a month towards the strips after you pay a $15 copay. Also, Omnipod called me 2 hours after the paperwork was faxed from my doctor to BCBS saying they had approved the pod. My son has only been on it 2 weeks, I hope they actually did approve it. Yikes!
