Oh yes…I vented on here with a post a while ago. The endo charged me $650 for an hour and 15 min. while the nurse practioner learned along with me. I was furious as they NEVER mentioned to me that I could have received that trainig for free as you said. When I advised them that my eye doctor’s office told me about a $65 dollar charge that wouldn’t be covered by insurance, they had no explaination for their lack of common curtesy. I fought with them for months before they took $200 off of the charge. How generous of them, right? They don’t like me there since I sat down with bookkeeping and asked for a line by line explanation of my billing! I insisted and received an additional $200 off because they had no “proof” of some of the items. As they are the only endocrinologists that handle diabetics who use insulin pumps in the area…I’m stuck unless I want to drive a considerable distance.
I’m sorry cause your right your situation sucks. Or I should say the doctor and his staff suck.
You have every right to get an explanation of what they are charging you. I’ll bet they would expect the same thing if they were on the other side of that charge.
I thought I got the info on some internet sight but can’t find it now. I could very well be wrong. I found one sight (which quotes from 2006 so you know it’s more now) $250-$500 per month for supplies and 6,000 (probably $7,000 now) for pump. That’s still $18,000 - $31,000 compared to omnipod at $21,000. I guess my point is the Omnipod is not much more expensive than any other tubed pump. And if you take an average $300/month supplies and $7000 for the pump it’s more = $21,400. Anyway… I think it’s probably more about the deals made with each company by each employer. It’s very hard to find actual prices, they don’t want to tell you… it’s scary.
I have gotten the paper work to fight my GM BCBS insurance which follows medicare standards. I was told the Omnipod is considered “disposable” maybe that means “not DME” All I’m sure of is it’s bullsh t! Any advice on what paperwork etc. you used? I’m filing through our DME supplier but not sure that’s the correct way. I think so because technically it’s GM BCBS not medicare. I called the top dog human resource person at GM and last we heard is that they are in discussions with someone.
I went to the ADA sight and on the first page was an area asking people if their insurance has denied them a CGM. Their collecting names/insurance information. Let’s hope it changes.
One idea is to contact JDRF advocates and complain. I have tried but so far they have not gotten back. If JDRF believes there is some harm and they have a powerful Lobby, maybe it will help.
I agree with you totally. Its hard to know where to get the best price and how it all shakes out in the end. But I do think the Omnipod is probably about the same in cost in the long run if not less. But there are a lot of people who forget to even take the supply costs of the regular pumps into consideration. They just assume that because the inital cost was less the than the overall cost of the Omni that the standard pump is cheaper. its not really comparing apples to apples.
barb what is the web address for the ADA? If they are collecting names I will throw mine in there.
We need to call Dr Berwixks Office he’d the Head of Medicare and Medicaid.
Maybe the congrees wiil listen to him… Since they are all republicans and only work to support the wealthy.
Thank you. That helps a lot , The more information you have the more able to have Medicare cover what you need.
Thank you again this is great to know.
I would gladly sign a class action suit against medicare for not covering the OmniPod. To think it is not covered due to proper coding... then Medicare needs to add the code! This is not rockets science but a complete utter disgrace that out government Medicare will not cover the newest technology.
You are correct. I have been fighting this for almost 2 years myself and had a hearing with an Adminstrative Law Judge.No result yet.
How about Medicare saying it is not covered because the Pod is not Durable Medcal equipment (DME) and then when you give a prescription for coverage under your part D Prescription Plan you are told it is not covered because it is DME!!!
Logical? Reasonable? Fair? That is what we are fighting. I will keep all interested advised and maybe enough voices, letters, and claims will make someone wake up.
Please keep me advised of any info anyone has.
Richard Meltzer
Richard I have googled to see if there is a current class action suit agianst Medicare for not covering Omnipod or Continuous Glucose Montors and have found nothing.
I am leaving soon for vacation and when I return I plan to contact our representatives in Congress to change the Coding for OmniPod so it is covered under Medicare.
What infuriates me more is that we the people, the taxpayers, fund Medicare and pay the salary and pensions of Congress, yet Congreess is not providing we the people with best technology available. It is downright disgraceful. They are telling us we are not worth the technology??? I am willing to put some passion into this and ask if you or anyone can direct us towards a class action suit, I am in.
Sadly, no this is not correct. Medicare will NOT cover the Pods.
Can I ask which Medicare Advantage plan you have that covers the omnipod. I have Humana advantage plan and they don't cover the Pod.
Thanks