Omnipod medicare coverage

#21

Thank you, Joey. Medicare is not user friendly. May be speaking to someone in politics. I’m certainly hoping for things to finally move in a good direction.

#22

I think it is ludicrous that a medical device used to preserve life is
called a “luxury item,” especially when some of the tubed pumps are covered
by Medicare. Who are we trying to kid, folks? The fact of the matter is
that this is all political. Some companies are in bed with certain
insurance companies and with Medicare, and others are not. Right now I am
covered through EdgePark with my insurance. While I am not entirely happy
with EdgePark, I finally have figured out how to deal with them. My concern
is AFTER I no longer have insurance coverage, which will happen in about two
years.

The last I heard, the Minimed pump was covered by Medicare, but OmniPod was
not. Again, why? How can a federal program favor one company over another?
That almost does not seem legal to me. Any why is Insulet not fighting
harder to get the Pods covered under Medicare? I know some Pod users have
knocked themselves out trying to get Medicare to cover the Pods, but they
are hitting brick walls. “That¹s just the way it is” seems to be Medicare¹s
answer. If anyone has any suggestions on how to convince vendors and
Medicare that Pods are simply another brand of pump rather than a “luxury
item,” please speak up. I would love to hear your ideas.

#23

Hi SherryAnn,
I will be working on a 2nd appeal to Medicare. I can’t recall ever being this stressed concerning D management.

Spoke to a lawyer with an excellent approval rating only to be told that it would cost about $5,000 and he couldn’t guarantee a win.

Insulet told me just what Jim2 said that Sullivan was in Washington this month to fight for Medicare coverage.

Might be dropping my Endo who, I believe, has little interest in helping me. Honestly, do not know what to do.
I’d even join a DC marsh any day to petition Congress for this long-awaited change.
Just imagine thousands of seniors storming the Capital.
Guess I’m just an avenger-at-heart!

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#24

Hi JoedyRose,

You and my wife Nancy have a lot in common. Both of you are around the same age and Type 1 diabetics. Although she has been a diabetic since age 7. If you would like to talk to her about Diabetic issues I’m sure she would be glad to do so with you. Also you should be happy you didn’t go through with those appeals to Medicare regarding the OmniPod, or your attorney and Insulet would be the only ones profiting from it.

FYI, we lost ALL our appeals in early 2015 all the way to the MAC Board (4th level) of appeal. The 5th and final level is taking your case to Federal Court where it costs big bucks as you mentioned so we told our attorney that we felt that this battle was no longer cost effective.

Lastly, don’t believe what some have replied to you regarding Insulet’s CEO Sullivan and going to Washington in support of the Medicare Community. I’ve written to him, and guess what, I’m still waiting for a reply, NONE to date!

Take Care & God Bless,
James

#25

I have read all the replies since I first began the fight some years ago.
I also took the issue to the last round of administrative appeals. In a long opinion, the Board denied coverage for a variety of reasons. Fortunately, it only cst me time because I am a lawyer.
I do not believe Omnipod is doing anything to obtain coverage, or at least no one admits to knowing if it is being done. You can try asking for its General Counsel who I believe is in house. He replaced the former Counsel about a year ago.
Even with Dexcom being covered it still has issues and a lack of coverage so it is obvious Medicare cannot and does not understand or appreciate the severity of its decision.
I guess money is better spent on building a wall!

#26

Richard,

Please click on the forum posting below to see what two of Insulet’s CEO Sullivan’s biggest supporters have to say on just how hard he is working for those of us on Medicare, and the Omnipod Pod coding issue that’s been going on for the past ten years now.

#27

Richard,

I did as you suggested, I contacted Insulet’s General Counsel by email, and he forwarded my email request to a VP on his staff who replied to my email Re: Omnipod getting coverage for its Pods under Medicare. The VP of Market Access requested my phone number, so I provided him with it, and now I’m patiently awaiting his call. He informed me that he and CEO Sullivan were in DC earlier in the week to have discussions with Medicare Reps and Congressional Reps so my request was as he wrote back was “very timely”. Lets see what he has to say, and I’ll report back here on the forums.

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#28

Great. Let me have his contact info so I can add my 2 cents

#29

Yes I just started on my Omnipod in Feb. 2017. I have been a diabetic for 22 years. I was on minimed previously, but thats another story. I was not planning on EVER being on an insulin pump again after recall pump malfunction in 2011. I was in intensive care for 3 weeks. Omnipod I thoroughly researched and off needles on POD!!! After I started with Omnipod, I received an email from Insulet stating that Omnipod is the only pump that Medicare will NOT pay for! I am currently on Medicaid awaiting my Social Security Disability Decision. So I am freaking out here in N.J.! E-mail SENATORS & CONGRESSMEN! They are the peoples advocate! I have even received help through the Congressman’s office obtaining HEALTH COVERAGE!!! I am with you on this one! All of us Diabetics are STRONG STUBBORN SURVIVORS! We fight to live every day!

#30

Oh by the way I am new to this wonderful community! I didn’t read all the same post that I put.