Insurance questions and misc

Hi All: I’m a current Ping user, former MM pumper.
My lousy HMO covers only fifty percent copay for a pump, and my warranty is up in Aug.
I’m wondering how insurance companies cover pods? My yearly deductible is $500, which I assume would buy something but after that, how does it work? Any info, though I know all insurance differs, would be helpful.
Also, can you wear a demo around and get a sense of if the adhesive bothers you etc?
And since I happen to have a hot tub, which I use once a day (usually at night) is it possible to schedule pod changes around a time like that?
I had not really even considered this before. I’ve read a lot of unhappy comments here, and so it is a bit scary. Right now I have to use angled sets (this is angled right?) and am very thin so…wondering about placement.
Just really not sure, but sure that I dont have $2500 to $3000 for a new pump right now either.
Thanks for any comments.

I’m told that BC/BS will not cover the Ipod, although they do cover MiniMed.

BC/BS will pay a portion of the Omnipod. My 11 year old son started in Dec. on the pods, we had to meet the deductiable first and then we pay about $90 out of pocket for a 3 month supply of pods.


Visit, you can even speak to a rep. about how your insurance will pay.
You can request a demo pod to wear.


Sounds to me like they can give you a pretty good idea. I’m going to call today.
It isnt blue cross…

I have BCBS and it covers my pod completely. I think it depends on what plan you have?

Thanks all. Just going to forget it.

My HMO goes through Carecentrix. The Omnipod folks just told me there is nothing I can do to even get an idea of coverage unless I go to them. Last time I called them I was on the phone for hours, with no real answers except that I can fund a $2500 payment through a plan.

Very upset, very frustrated.

Thanks for the info though!

PS Edgepark told me they would charge me fifty percent for every box of pods. So definitely no pod for me. That’s the way my insurance plan goes.

What you really need to look at is what your insurance pays for pump supplies, not the pump itself. The pods are normally billed from what I’ve seen as pump supplies. The “pump” portion of the Omnipod is around $500 for the remote or $200 during their promotions. If your insurance pays well for your infusion sets, I’d sure look at the Omnipod. It could save you from spending $2500 out of pocket for a new tubed pump.

Even if under warranty you might qualify for the Omnipod cut the cord program. You KEEP your old pump and pay about $200 for the pdm. We were still under warranty for our MM Revel and did Cut the Cord. The pods are billed as pump supplies so your warranty with Animas is irrelevant.

Yes, you can trial the pod.

No, wont work. I’m working with a nice gal at Edgepark, and she knows my policy.
She said my HMO bills boxes of pods as DME and would charge me fifty percent for every single box of pods.
She predicted $150 a month.
For that, I might as well either keep what I have or look into payment options in the future.
My pump supplies are paid 100 percent under Home Health Care (disposables) or something like that.
I cant believe they put pods in DME, because you would figure only the pdm is durable.
Really really stinks.

BCBS differs by state, and by policy. After deductible, pods are covered for us 100%. Several of us fought to make this happen. They were calling it a disposable pump, and were not going to cover anything. They are doing it now on a case by case basis, so not sure how hard that is going to be for others.

Hi Laura, I have Federal Blue Cross Blue Shield and Medicare is my primary. Medicare would not pay for the PDM but my BCBS did. Medicare does pay for the POD’s. Thankfully between the two I don’t have to pay a deductible for the supplies.

I still wonder if I should write a nice polite letter to my HMO and bring this sort of thing up.
I tried to figure out who to write to, and the girl only mentioned the appeals dept. I dont have anything to appeal yet, it’s just the principle of the whole thing!

Blue Cross around here would have been better for my hubby and I. But, they were quoting me $900 per month for two people and that was about five years ago. Recently they raised rates so high for their customers here, that there were legal proceedings. But I’m pretty sure they won their huge increase.
I’m grateful my supplies are covered, I dont pay anything for them.
I just wish the pump thing was a little more reasonable.

My son is currently on the Omnipod (different insurance), but I got an e-mail today that they added a feature to their web site called “Am I Covered?” It asked you for some information and will let you know what your insurance will cover. Here is the web address Hope this helps.

Yep, saw that. The customer service lady gave me the same info once she located my HMO and Dr.
It is a very nice feature considering most companies dont provide that much information.

That is the first time I have heard that Medicare pays for pods. I thought that people were still fighting for them to be covered? How long have you been getting them paid by Medicare?

Laura…Did you try and submit the request form for insurance coverage. I did not go with Omnipod until I knew how my insurance would cover and at the time I had BC/BS. I had to fill out a 1 page information sheet and release and a person at Omnipod did that work for me and after a week or two they called me back and told me how my insurance would cover after deductible and co-pays. My suggestion is to let them do the work although you’ll have to complete the form. Also I just got an e-mail today that they have a new feature on the Omnipod site. On the home page under “About OmniPod” and go to “Am I Covered?” Not sure how it works but maybe it can give you more information. Sorry your not getting as much help as what I did, I thought they were wonderful when I first inquired about insurance coverage. Good Luck~Schmutz

No, like I said, the feature is nice but the customer service person put my HMO in and told me since it goes through Carecentrix, there was no info she could give me. She didnt even offer a trial pod or spend another minute with me. Then I called Edgepark, and the gal said my plan definitely considers the pods as durable medical equipment and would charge me $150 per box.
I’m self employed and pick my own HMO plan (without a broker) and so I do have a pretty good idea of things like this. The pods were either going to get paid 100 percent, or be considered DME (which I think it stupid…).

Insurance is so frustrating. My starter kit was considered Durable Medical Equipment, and covered 100% because I went through an authorized provider. After covering it, they made a point to tell me that they had a lawyer look at their clause and they didn’t actually have to cover it 100%, and in the future they won’t. My monthly pods are applied to my deductible, as are all our prescriptions, and upon meeting our deductible, paid at 100%. In three months, my insurance will change, and I have no idea if I will still be able to use the pod.

I received the most help through my local Diabetic Education/supply center. They had demos of all pumps, answers, and were a great help in getting the questions answered. They were also great advocates in helping me get fair treatment to other pump users.

Yeah, I think they still dont know what to do with pods. I hope you are able to keep on with it.
We dont really have any local centers,but I am going to express things to my doctor when I see him in May.
Animas reps made this weird day where they plan to be in his office for extra consultation.
They tried to get all the pumpers to schedule to see him on one of two days.
I’m going to let them know how frustrated I am that even they wont help and I have their pump.