Insurance - Omnipod - Everything

Hello all,

I am seeking major help, I picked Omnipod for a reason so many years ago, and like we all know it is its own thing, yes, I have an it has its pros and cons but this is what makes my life better, less stress, and just manageable. I do not, and will not ever change to another, that is just me, this works for me, and it’s been forever, I shouldn’t have to test out other options to see if it works, go through a roller coaster worse than this one already is, maybe if there was one like this I’d consider, but there isn’t. I rather go back to MDI, which will still be (to me) like changing to a new pump, complications just waiting to happen, trying to get back in the rhyme of good patterns. Story of my life. And I AM NOT looking for people to “fight” with here I am looking for others in my position, still, or who had a work around with this following problem.

I will try and not make this too long or “rant” too much,

I only see a lot on the Medicare? not covering Omnipod pump/pod part not the PDM as the is under a Meter, which I believe it is now a thing that can be covered with rewording, (see 1 on bottom) now I have what I would think to be a normal insurance through work I have been Dia. for 10 years 9 of the 10 on the pod. I have had this insurance for 6, they have thrown at me before, one was for the test strips, we pay for them now cause it is the only one that goes with the PDM, they didn’t want to pay for them, the second was insulin in general fast an long (long for backup), they didn’t want to pay for what I had always been on, so they switched it to a different cheaper kind they would pay for, okay, changing these things can be bad, it’s not something you can just play with like its nothing…things for the most part I think worked out fine, other than money loss, and changing the insulin I was use to. Make my life more hellish why don’t you, I at this time finally feel like things are okay, (keep in mind this all didn’t happen right after another) my numbers an everything have been really good for once, the doc I have now has actually gotten somewhere, though I have been doing all the work lol, now this following issue, it’s been two months, going back and forth with everyone (insurance, doctors, Omnipod, others) trying to get more Pods, everyone is saying something different, one day they say it’s a “code” issue or because it’s “disposable” ( uhm aren’t all and any pump system you have?) an now it’s just a we aren’t going to pay for it, find a new one, not even a sorry or better yet A DAMN LIST that would say hey, this is what we can cover, NO, you all are going to sit there, not knowing a single thing about dia, and we are going to go back and forth on what YOU want to do with someone else life. Like I am loss for words, TWO months going back and forth, TWO, we JUST got a piece of mail last night about the you need to find a new get this cheaper pump. I have cried so much, why do we have people who know nothing about this make life or death decisions, I DID NOT wake up one day or plan in my childhood, let’s get Diabetic, it will be paradise. I couldn’t have done anything to prevent this?! You may think that is over exaggerated, but come on, you’re going to make someone change everything in their life again, loss of sleep, more stress then they already have, an so much more, and maybe it’s just me, but it’s not as easy as just saying oh okay, let’s switch to this, A, it doesn’t work, makes my life 10x worse in many ways, or B, you are just going to come back and say no, you can’t have this either because it’s not cheap enough for you…you do realize you can’t just stop being Dia for months right, the littlest thing can be game over. Why if anything could you not say anything a hell of a lot sooner like hey we are giving you a year to pick from these options or anything?! I will be out of pods soon, way too soon I don’t even want to image it, you’ll make me go back to MDI, which is not something I want at all, that alone is going to make me all wacky even if I did have another pump, same issues, loads more stress then I have now, loss of sleep which I don’t get now, and my numbers which in my book are great back to terrible, and throwing my complication chances up. I mean, I know what is thought, in my head, is worse than it may be, but this is in no way right, or justifiable in this world for them to do. I don’t know what to do because in reality, I see myself running out of my INSULIN PUMP and having to go back to MDI, and I would bet, thing’s will not be okay.

I mean even if you can’t help specifically with this issue, anything will help, the proper facts, images, anything that will help.

Again, I am not looking to pity, or smart comments, if you think someone will take offence to something, please don’t say anything.

If you have any questions please ask.

  1. Omnipod, couldn’t be counted as insulin pumps – since the insulin-delivering pod is disposable, it didn’t technically qualify as “durable medical equipment”
    To be changed to
    A “benefit category” - “medical supplies associated with the injection of insulin”

Thank you,
ßðð

What insurance company do you have?

Maybe I missed this, but was it covered by insurance previously but now it is no longer covered?

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To be honest,

My father and I work at the same company, and I am covered under “his” till I am 26, I only just turned 22 this month on the 7th, but even if I had it on my own, which I could do, it would be the same problems, if not more. So I am pretty much on my parents insurance till I can’t be, partly because that’s what they wanted, so again to be honest, I don’t recall the name, my mother does most of the phone calls, because I would more then likely “go at it” with someone on the other end who doesn’t understand anything, but Yes, it had always been covered, like I said we have run into problems before in general but they always get worked out one way or another, but this one is just to far in my book, an with the pump thing, we had an issue in the past with this an we had to do a tier call, it all got fixed, but now this issue of different answers an a its not us its them, to the letter two months after. I just am at loss.

Was there a change in the policy for why it is not covered? It is important to know the name of the insurance company and everything about your policy if you need to appeal it. Sometimes there is a lot of work that is involved in insurance appeals. You need to research what has changed and why it is not being covered anymore.

I mean it is something we can look at but No, only thing we have really seen is them saying, find a cheaper system, or like I said everyone says something different, before we got the letter saying that, it was a “code” or the word “disposable” being the problem, like I had mentioned previously.

And we have all the information, I just don’t know it personally off the top of my head, cause it’s not technically mine, an I don’t normally deal with them, my mother does.

@Boo

Not sure if you saw some of the other related posts but @Eric2 is the master of appeals. Particularly with Insulet. If you want any actual assistance with that process, you could have nobody better on your side.

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That’s great to hear, I just got a slight update, my doctor is having a conference call with my health insurance today so, I am praying something comes out of this, if not, we may have to figure something out.