Omnipod and Harvard Pilgrim

Diabetes Technology Insulin Pumps
1

I know everyone's health insurance plan is different, but I was wondering,

is there anyone who has Harvard Pilgrim HMO and uses the Omnipod?

I am having insurance issues and the Harvard Pilgrim guy said they stopped covering the Omnipod in Dec. 2011 - meaning no one with Harvard Pilgrim has the Omnipod covered.

This doesn't seem right to me. Harvard Pilgrim is a major health insurance company here in New England and that just doesn't seem to make sense.

I am in Massachusetts if that matters. Would love to hear from you if you are covered by HPHC for your Omni - thanks!

Kate

2

We are with BCBS of Michigan through General Motors and neither my Omnipod or Dexcom CGM were covered! Two years ago we were with HAP and I got the pod, no questions asked, paid in full. Insurance companies have an issue with the Omnipod. Don't know why, it's "different" it's "new" it's code is different or they can't make the money off of them like they can the Medtronic....who the heck knows but it's not right. Our insurance follows Medicare guidelines and Medicare doesn't cover either. Luckily several of us made calls and they actually changed or did something so that now we are covered! Occasionally you can fight city hall! Don't know for how long though. It could all change the first of the year. Maybe you can find others under this in the same company and start a calling campaign, that's what we did. All my best.

3

I'm in Plymouth, MA, and HP covers my pods. Not sure what criteria they make look at to determine eligibility but I pay nothing for Pods, just the Humalog.

4

thanks for sharing! I am currently trying to negotiate with my insurance company. Seems like some people are covered and some are not within my health insurance plan....

5

interesting... thanks for replying. I knew that it couldn't be true that HP has a blanket policy against Omnipod...of to continue "neogtiating" sigh.

thanks for responding, I really appreciate it.

6

I have HPHC in MA and have heard nothing about a change in coverage. Not that that means anything as I did not hear about the Freestyle test strip issue until I could not get any strips. I had to jump through hoops to get them to cover the test strips from Neighborhood Diabetes when no one else had them. I know they were not happy to have to use an outside provider. I would not be surprised if that is what prompted them to decide they do not want to cover the pod. That should not be an issue now that the newer Freestyle strips have been approved to use with the PDM. If you do not get the answer you want, ask to speak to someone else.

7

thanks - did you know that HPHC is now using Freestyle as its preferred and ONLY test strips as of April 1? I had to jump through hoops to get my Freestyle strips about a year ago and now they are the only ones you can get through HPHC (unless you have prior auth form from doc of course)

Also, as of April 1, HPHC will only cover a max of 207 test strips a month. I need 300 a month so have to fill out forms to be covered. Of course the forms are not available yet.

So many hoops, so many rules, but I will sort through it and get it all worked out! I can't imagine how an elderly person or person with significant other health issues would be able to wade through all this. It doesn't seem quite fair.

8

I about hit the ceiling when I found our insurance has a "preferred strip". When did healthcare become so smarmy and slimy with back room deals that determine what I use? It makes me furious.