Omnipod Application Denied

Our application for an Omnipod for my 12 year old daughter was turned down today. They have requirement that they will only approve the pump if a minimum of 6 months has passed since dx. Under that guideline, we have another 5 weeks to go. Hopefully this is just a bureaucratic requirement that can be satisfied in a couple of weeks. They also want proof of 4 endo visits, proof of at least 4 injections per day over 30 days ( no problem but not yet sure what kind of “proof” they want - hope our weekly log will suffice)

My handwritten logs were okay for our insurance to prove that we had been checking blood sugars diligently, so I would think that would be fine. I hope it goes well - we just love the omnipod!

Thanks for both replies. We do have our endo and Insulet involved. The call today came from the Insulet rep. The frustrating part was when she relayed the comment that we ( the insurance company) have to be certain that our daughter has type 1 diabetes.

Hopefully this is just part of the process and when we dot the i and cross the t for their checklists the issues will go away

I am a Type 2 and I had to prove I needed the pump with the results of my Pepctide (sp?). Fortunately, this showed I was below the threshold for my own body’s insulin production. This was the key to getting approval from BCBS.

I think it’s C peptide? but I have BCBS and I had to do the same thing and I’m a type one and have been for over 25 yrs, crazy itsn’t it??

We met with our endo today and the ball and hopefully she get this straightened out. Among other things, the insurance company said that they had only provided two weeks of BG meter readings. She showed me what her office had sent and it was meter readings going back into November. It looks like whoever was looking at the report, only looked at the first page and didn’t look beyond that first page.

Oh well, just part of the process. The good news is that my daughter received an excellent report from her endo today.

Larry -

Most insurance companies and doctors want to see at least a six month history before pumping. Most newly diagnosed type 1’s are still producing insulin at a much lower rate. They want the honeymoon period over so that your daughter will not suffer any sudden low blood sugars at night! Also, they want to have a routine set so that making the transition to a pump is easier for all. Six months is still early on. You will most likely see a number of adjustments over the first few months because , as you are learning , it ain’t the same for any two of us!
I wish you, your daughter and your family luck with podding. Here ae some tips:
utilize the regional sales and clinical rep from Insulet
utilize the product support for all concerns
be the boss! This is your daughter’s life and do what is right for her!
my best to you and yours…


I appreciate the input. Thanks a lot.

Fantastic news. We reapplied on the six month anniversary of dx and the application was approved within a day. Supplies will be in early next week and we have a training session with the endo on the 14th. Our daughter is so excited to start pumping.