Insurance question

Hi all,

Since we're still really new to using the pod (our daughter started in January), we've only just received our first bill and are a bit confused. We were told our insurance (Cigna) would cover it 100%, but apparently they didn't really mean what we heard. They are considering the actual pods as diabetes supplies, as opposed to a part of the pump, so while they did indeed cover the pdm at 100%, the pods are only covered at 80%, and that after the deductible is met. Which means, of course, a bill every 3 months, and a pretty large on each year if our deductible is not met for other reasons.

I am just wondering if this is the norm and if it's worth debating it with our insurance company to help them understand that the pods are actually an indespensible part of the pump system. Is it just that Omnipod is just still too new for them to understand?

Thanks for any input!


Hi Spooky,
And, as such, is it covered at 100%, if you don’t mind my asking?

Our insurance only covers 80 percent for both pods and the PDM. =( I think we pay around $80 a month.

The pods are generally considered DME, which few plans will cover at 100% to my knowledge. I have to pay my 20% copay every three months. On my last insurance, it was a 10% copay.

My insurance covers it as durable medical equipment so it is covered at 100%. I have Keystone East which is a PA version of Blue Cross Blue Shield. They’ve even started covering my test strips at 100% since the Omnipod requires a certain kind of test strip. It’s made my costs go way down. You need to figure out how your insurance company covers infusion sets for other pumps, the pods should be covered the same way.

My insurance company considers both the pdm and the pods as durable medical and I pay 20% of the cost after a $500 deductible.

I must have a different Cigna flavor. I didn’t get a bill for my pods. I have not researched whether this is right or wrong. It does not matter. My copay limit is $500/year. I will reach this limit with or without pod copay.

Thank you, everyone! It helps to see, at least, that there is a range.

My wife’s employer’s version of Aetna pays 100% after a deductable. Because I had met my deductable for 2009, my PDM and two batches of pods were covered 100%. In 2010, other members of my family had met the family deductable so my only order of pods this year was also covered 100%.

My employer is a very small company and therefore has HIGH insurance costs. Our plan is Blue Cross Blue Shield Texas and it is set up like our last 2 plans with other companies. Each employee has to pay a High-Deductible amount before the insurance company pays anything. We have to pay $2500 per person per year up to a total of $5000 before the insurance pays for anything. After that, it covers everything at 100%.

Because of the high deductible plan, we qualify for a HSA (Health Savings Account) which allows us to put money into an account pre-tax. So my employer and I both put $2500 in pre-tax and that covers the bills for the year. After that, everything is covered. Except the monthly Premiums, which go up about 30% every year. Yay! J/K

I have blue cross blue shield through my husband’s company… the PDM and pods and covered 100%. I never paid a dime for them.

This is exactly how my insurance covers it as well. Then my test strips are considered a “prescription” so I pay $60 for a 3 month supply like my other scripts.