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.
I was having a same situation and gone through third party distributor, after switching insurance from AETNA. There are couple of distributor you should check which I have used for Omnipod and Dexcom sensors since then. They are pretty reasonable and make sure get quote from both distributor (one of them price matched for me).
Advance diabetes supplies (Talk to Sheila @ 760-579-7407)
Diabetes specialty center (Talk to Desiree Western @ 800-775-4372 x68792)
Hey, thanks! So you switched vendors and that worked?
I've just been hesitant to switch providers and maybe have to go through getting the endo to fill out their paperwork -- and get two different claims going with UHC, while they're appealing it.
I really don't know what to do. Never seen anything like it.
Yes, it worked. I'm getting next refills this Thursday. Pretty much same copay I paid, which I was paying it with AETNA. I have insurance through employer , so no choice. Personally, I like AETNA better but I haven't came across any issues with UHC so far.
Regarding Endo, distributors are going it to do it for you..Just provide your insurance and Endo info..
I have UHC and had to go through Edgepark because they won't deal with Insulet directly. No issues here at all though. You may want to double check who UHC will allow you to get supplies from elsewhere to avoid a bigger mess. But Edgepark should be able to resolve this for you. Do you have a contact that is working with you there? Have a name of someone to contact. And you are talking to the pump supply folks specifically? It is a whole separate department. I'd follow up with them daily to get a fire under them to get it resolved, and have them even send you some no cost supplies until they get it resolved for you.
I am dealing with this issue for my father, with no luck. They are refusing it because it is disposable???! They are making him switch to a different pump, despite appeals. His UHC plan is Medicare, I’m not sure if that is what is making the difference? Who did you talk to at edgepark?
I have united health care and it was a ■■■■■ at first. You have to explain that it is durable medical equipment which their pharmacy does not offer so you have no choice but to use Edgepark. They take UHC from me and I have to first meet my deductible then I pay 60 bucks for a box of 10. I get 3 boxes at a time for 180. I ended the tiresome endless cycles of conversation with UHC and only deal with Edgepark. Knock on wood, no troubles. Hope this helps! Happy Pumping!
Thanks all for the tips. I just got a call from Edgepark and they said my appeal has been denied.
Is anybody who has United Health Care getting Omnipods from a vendor they like? I'd like to find a good contact who can navigate this. A name and number would be great.
(I didn't have any issues with BSBC and -- sorry -- I was saying UHC and I think some folks who responded thought I meant medicare. walkingonthemoon: I loved Aetna but they are long gone for me. I really need somebody who's good at dealing with United Health Care. This is such a bummer. Katkat, I'm dealing with Tim at Edgepark, who's in Diabetic supplies. He just called and told me to call United Health Care, which I've done 1/2 a dozen times with no luck.)
Did you check with the contacts I posted earlier? For me it worked really well. My insurance was changed since start of this year and UHC had no objection to OMNIPOD, when I went through 'Advance diabetes supplies'... (I dont get commissions from any distributor..lol)
I paid $30 per box after the deductibles (depends on your insurance/copay)
Other than that, UHC told me that following insulin pump providers works directly with them:
This is a huge help--I wasn't sure if you were using United, so I was waiting to get word from somebody who was definitely using them and getting pods, and a name/number. I'm going to try Advance diabetes supplies and the contact you sent. I also called insulet and asked them for a name, and they're supposed to call me back, but who knows...Again, thank you! I feel like my HR dept and insulet, edgepark--nobody seems to be able to help, feels very lonesome. Cool to have my T1 buddies' advice.
I talked to Sheila at Advance diabetes supplies and she's on the case. She seems very together (and picks up her phone, which is nice.)
Insulet called and said they reached out to Byram Healthcare, who's supposed to call. Insulet seems to think Edgepark and Byram are the only vendors who can deal with United Health, which seems strange.
Anyway, hopefully some of this is helpful to others down the road. I'll report back when/if I get some movement.
I am using United Health care in NY. I get all my diabetic supplies, except insulin, thru Liberty medical which contracts with United in NY. The coverage is fantastic. I pay no copays whatsoever & I am getting 5 boxes of pods every 3 months! I only asked for 3 boxes but when I was called by Liberty to reorder after 3 months, they told me United would cover 5 boxes under the insurance so If I wanted 5 all I had to do was ask for them!
Sheilla at Advance diabetes supplies has been super responsive and straightened everything out in, like, a day. My coverage will also pay for a new PDM, so I'll have a backup. This is night and day--I've been so, so stressed. I wish I had thought to talk to you guys before, but hopefully this'll help a pumper in the future.
So glad you got your situation resolved! I figured I would post another pharmacy option for UHC just in case anyone else is searching the site for answers. Focus Pharmacy is another great place to go, specifically if you still pay a copay after meeting a deductible. They have excellent customer service, get pods to you within 24 hours if needed and accept insurance payment as payment in full for those who qualify. I would have never found them if another member hadn’t posted about it.
Hey, that's terrific to hear. I really never got anywhere with Edgepark.
Not only did the person I dealt with get me the pods right away, because it's new insurance she got me a new PDM, so now I have a backup. It was at no cost, like the pods, after I met my deductible.
This was after months of getting nowhere, couldn't get a single pod. Makes no sense. But I'm glad there are good options out there. Appreciate everybody sharing their tips.
One other thought--where else are people gathering, sharing, reading up and getting advice? Do most people use Tudiatebes only or ... just wondering where else to get practical advice from others. That's a little off-topic, but I so appreciated the straight-up tips on this situation, a lifesaver.
I have had good luck (although it was kind of forced on me) with Advanced Diabetes. The one minor quirk, is that they ship pods each month instead of every 3 months like OptumRx/Medco did. They call each time in order to make sure its "ok" to charge for the next month.
They were very upfront that it would cost me the same amount for 1 box per month, or 2, so I appreciate that. Had my Doctor re-write my script and that way I have built a supply of pods in case I ever come across a bad lot.
