I'm having a maddening insurance problem -- aren't they all? -- with United Health Care and omnipods. I've been using the omnipod system for years, first with Aetna and then Blue Cross. But I switched to United Health Care, and generally speaking the insurance is very good. But they're -- at least initially -- refusing to cover the pods and I can't figure out what's up. I'm having to go through a third party, Edgepark at the moment, which is also new. I've always gone through Insulet. Edepark says they deal every day with UHC, so they don't understand what's happening.
The first request was rejected because there was no pump, just the pods. They didn't seem to understand the pods were the pump. Then an urgent appeal was created, but rejected. A standard appeal is underway, but I've run out of them long ago. I keep calling insulet and having to order them directly out of pocket. I keep thinking this will get worked out, but it's been months now.
Is anybody using United Health and the omnipod through a third party? I'm supposed to be getting them covered at 100 percent now that I've met my deductible. It was always a 70/30 or 80/20 split with BC/BS, which was fine with me. But now that my insurance is really good, and seems to cover them completely, I feel like I'm getting stonewalled. Calls from the endo, urgent appeals for Edgepark, getting the issue escalated through my HR department--none of it's worked. I'm about to make my third order directly to Insulet to keep me going. I just wish I could get some resolution.
We use United Healthcare Oxford? Is that the same as yours? My daughter is on the pod and we did not experience an issue. Of course my husbands plan (not provider) has changed as open enrollment has just ended for him. Always worried that issues will arise with the new plan year.
Your picture doesn't look old enough but have you recently gone on Medicare? If you have, that changes the whole procedure because Medicare does NOT cover the pods so my insurance has to have an EOB from Medicare stating that they will NOT cover them before my insurance company will pay. This same insurance company has been covering the Omnipod since before I was on Medicare and that was in 2010. Since I've been on Medicare, I have had to use a 3d party provider, ie Edgepark, Solara, and Liberty, who will submit to Medicare and get a refusal that they then submit to my secondary insurance which does pay them once I meet my deductible. This may be of no help but at least it's sympathy for the frustration and the expense you're enduring.
I recently had this experience. I wanted to go with the OmniPod for site reasons - and am tired of the tubing with my pump. They have denied my request - but I think UHC does not really "get" it. I have decided that I will just stay with Animas - and go for their new pump.
I can see why you'd want to stick with Animas -- the situation was really frustrating. But these guys fixed my problem overnight:
Advanced diabetic supplies 866.416.8088
I'm not sure why I can't find this info on this thread--it was recommended to me by a previous TuDiabetes user, in an earlier reply.
Edgepark, who Omnipod pointed me to, just could not get it done with UHC, over two months. And every time I talked to the rep at Edgepark, he'd read a disclaimer to me and make me listen to the entire thing and accept it before he'd tell me why he was calling. And then they're just gave up on the whole thing. Crazy. And the reps at UHC were useless. It's like you're talking to a robot--hate that.
But the people at advanced straightened me out and I've been happy ever since. Super nice people with ninja-like efficiency. Another company was recommended and
These were the two companies that were recommended to me:
Advance diabetes supplies (Talk to Sheila @ 760-579-7407) Diabetes specialty center (Talk to Desiree Western @ 800-775-4372 x68792)
Also, Sheila at Advance got me a new PDM too for free, because my isurance was new (new job.) Can't say enough good things. I'm not 100 percent Sheila still works there, I dealt with somebody else last time I re-ordered and that person was very nice too.
