Omnipod and BCBS

Hi everyone,

Has anyone out here heard that Insulet is now out of network with BCBS? I called the first of the year to give them my new insurance info and the lady told me that they did not carry BCBS. So I went to Edgepark and was about to call them back to place my order when Insulet called me and told me that they are in network with BCBS. So I placed my order with Insulet and now it's been 2 months and they have not process my claim. I've called twice asking them what is taking so long. The first time I called I was told it was sent to the wrong BCBS and that they resent the claim to the correct one. After another month and nothing was showing up I called again and then was told they are out of network. He then told me that Insulet is in the process of trying to renegotiate their contract.

Is there anyone else out here on BCBS and using Insulet or were you directed to a 3rd party to order your pods?

We use BC/BS of NJ and buy directly from Insulet.

I am currently on bcbs of Louisiana. I was just accepted for the omnipod and dexcom. I went through pumpsit. I highly recommend them. They know how to work with insurance and are very personable.

Scott, have you placed an order recently? I used BCBS of TX last year and didn't have any issues. Now I'm told that Insulet is to get a contract renewal with BCBS.

Thanks Benjamin for the recommendation.

BCBS of California renewed me at the start of the year.

Here's my story....I received a notification addressed to Insulet but to my home address, stating that the claim had been mistakenly sent to BCBS. I was directed to and they forwarded my information to Central States. A few weeks later, I receive a check to Insulet for the usual insurance payment--which I forwarded to Insulet. This was for a shipment w a a y back in September of 2011. YIKES!! Are they that far behind?? When I recently called to place an order, I was told that BCBS was no longer making paymments. I was given the name of Doubek Medical Supply (in Illinois). They actually called me. They asked me a few questions and I received my shipment in a prompt and timely manner My out of pocket is slightly higher. I also ordered my test strips through them--they were $20 cheaper.p>

I'm on Keystone BC/BS in PA. They've always made me get my pods from CCS medical. It's never been a problem though.

That is strange because they keep telling me that they are taking BCBS and eating the difference between in and out of network. I believe I will start going through Edgepark. When I called them in January they told me that they were in network with BCBS. Now I have to get my $400 deductible from Insulet because I went ahead and paid my deductible with them and the remaining cost. Because they haven't processed my claim I had to pay my deductible on another claim.

With my company's BCBS plan, I had to get the Omnipod fulfilled via
a 3rd party DME provider - in my case, Better Living Now. Then the pods were filled via our pharmacy provider, MEDCO. I was told that this was because Empire BCBS [NY]did not have a contract directly with Insulet. I do not know if this applies to other plans...

I have bcbs and was directed to a 3rd party (liberty) to order my latest package of pods just for that reason.

We also have a bcbs and my december shipment was all of the sudden billed as out of network with a seperate deductible. I was on the phone and after bcbs blamed insulet, insulet explained that they had been billing all bcbs claims through bcbs of massachusetts and now bcbs is requiring insulet to get a seperate contract with each individual bcbs plan. Insulet ate the $800 extra this cost us and only billed us like they had been participating. They then set us up with doubak medical supply which is working just fine.

To me this just illustrates how cumbersome and beaurocratic our health care system is. There has to be a more efficient way.

No problem here, with BCBS Federal Employee plan. I received my first shipment of the year a few weeks ago and got the normal bill (deductible + co-insurance).

I think I'll be making a preemptive strike. There's no way that I'm trying to just roll over and pay extra when I had no warning that something was afoot.

I have an insurance claim pending to BCBS of Alabama since about last August that they still havent paid to Insulet. I was told this by a rep who also said that BCBS no longer has a contract with them and will probably send me a check for the payment that I should send to them. Im not complaining though because that has postponed me from having to pay my copay. I switched insurance at the beginning of the year though so im not sure how things would have played out.

BCBS of North Carolina also does not have a contract with Insulet. I was told about it in January by Insulet. They tried to send me to Edgepark and said Edgepark would call me to set it up. After 3 weeks and no call from Edgepark, I started calling around and found Better Living Now. They called me right back and seemed responsive. I got my first shipment of pods from them in February, and will be getting my test strips from them also. So far, so good. BCBS is different in every state it seems. You have to stay on top of them like we have to do on everything related to this "diabetes thing"

Thanks everyone for the info. I was wondering if BCBS is different for each state. I guess I'm going to have to give Insulet a call back to see about getting my $400 deductible that I paid them in January and then switch over to Edgepark. I used them when I was on United Healthcare and they have me on file.

I just wish that Insulet didn't call me back in January telling me that they did carry BCBS then I wouldn't be in this situation with them.

It's so frustrating. You are right Hank you do have to stay on top of anything that is diabetes related.

I use BCBS of Montana and had been fighting with them since last August to approve the Omnipod for me. At the first of the year, I was told the same as you were with the exception that I would have to work with Edgepark to finish my appeal instead of Insulet. I highly recommend Edgepark as they did everything they could to get me the OmniPod and I am proud to say that I started on it this week! When Insulet told me that they would no longer be able to help me, I called Edgepark directly, got my rep's name, and have been in touch with him ever since. I hope that you get this figured out quickly! I know how frustrating it can be...

I can call Insulet to order my supplies but I have to go through a third party for billing. Its been that way when I had BCBS and even now with my new insurance of Cigna. Both are a pain in my butt.

I just tried to reorder from Insulet, which I have done many times with BC/BS of Texas. I was told that due to contracting issues, Insulet is now out of network, and I have to use a third party distributor to obtain in-network benefits.

I'm not happy. My experiences with third party distributors have been uniformly awful. The newest distributor (Byram) assured me on Wednesday that my new order of pods was on the way and that it would arrive on Thursday. On Saturday afternoon, I still do not have them.

Insulet needs to get this fixed.

Just to add to my previous post... . I called Byram today, and they told me that they did not actually have my shipment of pods shipped next-day as they had assured me. My pods will finally arrive tomorrow (i.e., almost two weeks after my first contact with Byram).

Again, Insulet needs to get this fixed.