Is the omnipod an insulin pump?

We all know that the pod is really a pump, right?

Would you like to know that our sophisticated medical people at Medicare do not take that position. For some unexplainable reason, and despite the clear regulation stating coverage for pumps, medicare refuses to cover the cost for the omnipod. Because it has no wires or is too new to establish a code, or some other irrational reason, coverage is rejected. Can anyone shed any light or assistance to this area of growing concern?

Richard Meltzer

Hi Richard,

The short answer is “Yes, it’s a pump.” The pod is a wearable pump with a wireless hand-held controller (the PDM). The Omnipod system is made up of two devices, the pod and the PDM (Personal Diabetes Manager). Call Insulet and they will help you to get approval.

Cheers,
Gil

Can you believe that some people want government to take a bigger role in healthcare.

I’m sorry, but because there is no visible, tangible tube or wire running between your body and the pump device… it cannot qualify as an insulin pump. It does not matter that the manufacturer of said device can give proof that the pump is in the infusion set. Because “I CANNOT SEE IT”, it must not exist. Have a nice day.

Yes, they think it’s a dermal patch. They don’t realize that there is a pump and a cannula insertion mechanisms inside.

They also think airplanes need to have propellers to fly. :slight_smile:

If they would take to time to open up a pod they would see that it does have a tube!!! The tube, the needle, and the canula are connected. Looking carefully you can see the needle retracted up inside the canula while on the body. Maybe Insulet could straighten this out for you.

Richard ,.I have been fighting this issue since last July…If I was not on Medicare, I would be covered for this with my insurance., . Medicare it seems, DOES NOT COVER THIS PARTICULAR PUMP. I have had many people fighting for me, now …
…I am now going to my Senator, and Congressman. maybe even TV…
It makes no sense that ins would cover it, but whenever I order, I am told" we follow medicare guidelines"…sorry!
Medicare DOES say it will cover pumps, I have it in writing in their literature, My insurance co. said to submit the bills from the supplier, I have and still waiting for reimbursement…Where do you live Richard? I am in SW Florida.

PS… I have had a great gal from Insulet who has tried to help…NO LUCK!

I do not know if you have my reply so here it is again.
I have spoken with several persons at Insulet, including a gal named Lisa, who agree that medicare will not cover. It seems there is no code for this type because it is wireless.
I would like to know what info you have to appeal and your success. I am an atty and will fight this. I agree politicians may help, but Insulet really needs to become more vocal and provide support for us. It took several months for them to file a claim that is just now denied.

This just drives me crazy that once again insurance companies or now even the government is fighting a medically prescribed treatment! I want my healthcare run by my endocrinologist, not by some snotty clerk in an insurance company or a clueless medical coder who got her job with a one year technical diploma. They won’t cover the OmniPod because there is no CODE for it?! Then MAKE a darn code for it! What is so hard about that? Before the 1990s there were no codes for many of the medicines commonly used today, but somehow they all came into existence. Why not the OmniPod also? I pay a bundle in taxes each year so programs like Medicare are funded; maybe we should all complain to our Congressmen.

I hope that as an attorney you do fight this ruling. Isn’t there something in the Americans with Disabilities Act that says people cannot discriminate against someone because of a medical condition? If an MD prescribed a legitimate medical device, then Medicare should cover it. Don’t they realize that with the better control you will get with the OmniPod, they will actually pay less for your medical treatment in the future? Additionally, if you factor the $9,000 up-front cost of the traditional pump and the cost of the insulin, infusion sets, etc. over the normal four-year life of the pump and then factor in the cost of the PDM and a four-year supply of Pods, you will see that the cost differential is negligible.

Fight for it, Richard, and keep us all posted.

Gil:
I replied to some of the responses, but I have spoken with Insulet and, unfortunately, they cannot be much help. They realize that for coding or other reasons medicare will not approve it. Medicare does not state why other than coding is a problem. I believe Insulet has tried and is frustrated. My only remedies are to appeal( as an atty, I will enjoy taking them on) or going to a carrier and have an HMO which I do not want.
I know Regs say pumps are covered and I need from Insulet documentation that FDA approved it as a pump and a comparison with other approved pumps and the pod. I am willing to do this which really helps Insulet but cooperation is a little lacking. Do you know someone I can speak to directly?

well it’s a really heavy dermal patch then.

Doesn’t matter if you have an HMO, PPO, …
The answer you will get from a supplier, is “We follow Medicare guidlines and Medicare won’t pay for the pods”. I have been through this over and over.
As you must know, Medicare says in their literature, they will pay for insulin pumps. They won’t pay for the omni pod.
Good Luck Richard, Please keep us/me informed if you have any success…I am going to my representative, and State Senator, and see If I have any success…
Nadine Kaliner
sunflwr126@aol.com