Omnipod and insurance!

Still waiting to hear if my insurer will cover Omnipod even though they claim to cover it 100%. Insulet has bumped my request to a higher management person to figure this out. They mentioned something about shared risk. Getting frustrated as my insurer gave me the Decom 100% no questions asked.


Insurance is so much a problem any more. Time is your best friend right now. There is never a rush on things like this.

Are you in the us or canada?

I have Blue Shield of California, through CalPers, which is actually great insurance. Not sure what the problem is as the insulet folks tell me things the insurance company says that make no sense.

I agree that this is a growing problem. At my employers choice, I had to change to a plan that only covers my omni pod and Dexcom at 100 % AFTER I pay all out of pocket and deductible expenses. I am very stressed over this. I may have to investigate other options that are covered at 100percent prior to OOP and deductible. (This is a Cigna plan btw). And for me , time is a factor as the auto refill option kicked in before we had all of the details worked out and my new shipment of pods could be very expensive. Any tips out there?

I think that is part of it for me. How much would I be charged after in insurance pays and how I could keep it up. I’m retired and on a limited income.

Keep at it don't give up they will cover it but it will be a battle on ur part just keep bugging them. In the end it took mine old pump to become broken before they would but they did. And it was state insurance too. Good luck. What might help is what I did keep a record of everything. Make a list of all the pros and con's of the pod compared to the tube. And talk to the doctor. Its all about those codes

Just be aware that when you go on Medicare, no matter who your secondary insurance is, they won't cover the pods. Medicare considers the OmniPod System a "Luxury". I've been on it for 9 years and now I have to find another pump that they'll cover. I just went on Medicare July 1st and found out last week they won't cover it. I tried everything and so did my Doctor but they held firm to their decision.

I’m 55 so I have a few years before that. But thanks for that info.

I’m so sorry, are you going back to shots or choosing a new pump?

I'm choosing a new pump but there are no other remote control pumps, just tubing but I'd still rather do that than go back to needles and figure out all the boluses. I did that for 2 years before I knew about any pump and I definitely got spoiled with the Omnipods. lol

You're welcome. The representative from OmniPod told me they're trying desperately to get Medicare to insure their products. Hopefully in 10 years they'll be successful. Good luck to you. :-)

And to you as well.

Thank you. I'm going Friday to learn about the different pumps that are available that are covered. It will have to be a "tube" pump but that's better than going back to injections and figuring everything out myself.