I knew I was going to switch insurances when my wife left her job but I called the new plan (still a BC/BS product) and was told my prior approval should transfer right over. However, I didn’t realize you needed to make a minimum amt of money to get on this program (we have state sponsored insurance in VT that you can get on). I’m on a program that is governed by Medicaid rules so you probably know where that leaves me (nowhere). Pump person from doc’s office is following up and said that insurance said they would do it with a prior approval but wouldn’t sign a payment agreement but I haven’t heard anything from her in about 10 days and I keep calling and leaving messages as I’m down to a few pods (I realize I’ll prob have to buy at least 1 mo on my own even if insurance comes through). I even called Insulet and got to talk to the person who talked to doctor’s office rep and she said that the hold up is that the insurance won’t sign the negotiated price agreement since they have no contract with Insulet (since my plan is governed by Medicaid rules)
I know the cash price with Insulet is $365. I can get them for about $335 through American Diabetes Wholesale.
I just called Edgepark and it seems like I would pay $520/10 pack. The rep said I would get a 20% discount off the catalog price of $650. Medicare, Medicaid, I think they are both governed by the same rules.
If you are paying $520, you can get them cheaper from Insulet and American Diabetes Wholesale.
Thanks for the response.
I have to beleive things will change with Medicare by the time I get on it in 17 years or so! I don’t plan on giving up the pod!
Good news! Finally got a response from doc’s office and she said I should go through a diabetic supply company in MA who has a contract with my new insurance and they should be able to supply the pods to me and get payment from my insurance. Keep your fingers crossed!
When I was on Oxford insurance they were only paying Oxford $275 for 10 pods! Now I’m on Empire NY State insurance and I dont know what they are paying since I have to go thru Liberty medical. I’d give Liberty Medical a call to see what they might be able to do for you.
Please contact the Insulet customer service number located on the back of your pdm and on the packaging for each pod… paying $500.00 for a box of 10 pods is preposterous! The cash price for a box of 10 direct from Insulet is considerably less than that. Please advocate for yourself with Insulet and your insurer as you are getting ripped off. Also report your current provider to your state insurance commission. This sounds like robbery!
Solid question… you should be able to get good direction from the people at Insulet. They of course should know who they are supplying as well as what insurance plans work better with which provider. Certainly there is also a list of providers that your plan has to give you but then it is a hunt and may take a long time and to many calls and a lot of 1/2 truths. Contact Insulet directly and put them to work for you, after all you are their customer and contributing to their bottom line, right?
Best of luck…
Liberty medical ans Edgepark both handle insulet pods. If you have them coded as “reservoirs” there should be no problem getting them instead of say, the infusion site reservoirs of a tubed pump. I am on medicaid, and my friend is medicare assigned to Humana. When I was approved on the medicaid program, I let the durible med, prior auth dept. know the DME’s that carry the pods and sensors. Then it turned out that they already had a contract with edgepark. DONE DEAL!! Although it sucks to have to deal with a dem that far away (time zone and shipping time issues) since several West Coast DMEs have them, but no contract with my carrrier.
