Omnipod & Insurance Question

I’m really stoked about getting an Omnipod, but I’ve got to wait until July 2010 (that seems forever away!), because I got my Minimed pump in 2006, so it hasn’t been a full 4 years yet.

I’m trying to do as much research as possible between now and then so that my parents don’t have to do quite as much work like they did in the past. I’m 18 now, so I feel like I should be pulling my weight, too.

Anyway, we’ve got Kaiser Permanente for our insurance and healthcare and all that. If anyone else uses Kaiser, is there anything we should know about dealing with them? I know when I wanted to the the CGM, we met some resistance with getting that covered, so I decided it wasn’t worth all that effort, and they’re so expensive without insurance.

And of course I’ll talk to my doctors and parents and everyone I can think of before making the switch, but I’d love to get your opinions and tips too. Thanks! :slight_smile:


Not only that, but Omnipod offers a discount on the PDM (they’ll sell it for $299.99) for people switching from another pump to their company. They’ll let you keep your Minimed as a back-up and won’t require it as a trade-in either.

If you really want to get on the Pod now, it might be worth paying the $300 out of pocket for the PDM, sitting on your leftover Minimed supplies as back-up (and you’d have an in-warranty back-up pump), and then only dealing with your insurance to get your 3-month shipment of supplies from Insulet instead of from Minimed. Slightly more expensive per supply order, but not generally a problem. It’s often the initial price of a new system that an insurance company will turn down if you already have an in-warranty device.

Anyway, that’s exactly what I did switching from my in-warranty Cozmo to Omnipod. When I called my blue cross plan, the rep said, “Why would we care who you get supplies from as long as their a provider on your plan?” and approved it without question. I paid for my PDM myself, though at the time it was just $50 for Cozmo users and they hadn’t extended the offer to users of other pumps yet.

Kelsie, CGM approvals are way easier these days. A lot has changed after the JDRF study came out last fall.

Thanks for the info guys! That’s pretty exciting!

I have BCBS insurance…I had to win an appeal to get the pods covered by them. I won the appeal and they pay 100% of the costs for pods. Insulet was the driving force to win my appeal.

I just got the Pod thru the upgrade offer Insulet has right now. I’m only on pod #1, but so far so good. It’s weird - all day I’ve had this feeling like I’ve forgotten something and it’s simply b/c I don’t have to reach into the bra every hour or 2 to either bolus or stop the beeping. I had a few hundred dollars left in a health savings account that are use or lose so I figured I would use them on this. My insurance approved the supplies w/ no problem at 90%. My script w/ Minimed lapses this month so I won’t get any more shipments from them (unless they continue to re-supply me with my recalled sets) so I’m basically good to go. And I always have my 522 as backup if the pods don’t really work out.

I have BCBS also. I had a minimed 722 which was out or warranty but working. They reviewed and said no way. If it was broke, they would cover it, but if not I was on my own. They covered the pods but not the PDM. I did the upgrade for the $299. I think it was worth it and I now have the minimed as back up.

I have Aetna, and my switch from MDI to pump was approved. My control was so bad that my CGM was approved in 4 hours. I have to pay a $250 deductable each year for all durable medical equipment, so each yearI have to pay the first $250 for pods and CGM sensors.

Bradley, make us CGMers proud. The trials show that CGMs don’t help people with high A1C because they just don’t care. Prove them wrong.