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.