I’ve been an omnipod user since 2014. A few years ago, they started leaking. After calling Children’s Hospital of Pittsburgh about 1.5 years ago, I was told to push down on the pod when inserting so the cannula gets deep enough in the skin. I worked for awhile, but it started again a few months ago. I decided I’m sick of the omnipod. My ratios and basals are insane; my lowest ratio is 1:3 and my basals fluctuate a lot. My lowest basal is 0.05, and I still go low everyday at that time, and my highest basal is 1.5, and I still go high at that time. I’m sick of the leaking and the crazy sugar levels. I want to switch to tslim. I feel that I need a longer cannula in order for the insulin to absorbed better and to avoid leaking. I noticed that no matter how low my ratios are, I go high as soon as I eat. Even if I give my insulin 15-20 minutes early, I go high the minute I finish eating. I have an issue though. My omnipod warranty ended last year, and my PDM had an error around the same time so I needed to get a new PDM anyway. They said they had to renew my warranty in order for me to get a new PDM. I know nothing about insurance or anything but I know we have medicaid. We didn’t pay anything for my omnipod or my dexcom. I know I don’t have a lot of information but my mom doesn’t want to call about it. I just want to know if it’s possible to get a new pump while still under a warranty and have it be covered. Could my doctor say it’s medically necessary to switch?
Since you successfully used the Omnipod for many years, I suspect that your preferred infusion sites have become resistant to good absorption. The insulin leaking you describe is something I’ve seen termed, tunneling. When the infused insulin is pumped into scarred tissue, it resists absorption, pressure builds at the cannula tip and it finds a path along the outside of the cannula and to the surface of the skin.
Have you tried to use any infusion sites that you’ve never used before? That might help.
I tried the Omnipod several years ago, after using tubed pumps for decades. I gave up after five months due to uneven absorption. I think the fixed length and angle of the cannula was just not a good match for me.
I can’t help with your insurance question but I think you should get some useful information from someone who knows how Medicaid works. You might consider doing some research to identify some source of information/help from Medicaid.
I understand your mom’s frustration with sourcing diabetes supplies. Maybe you could consider this scenario as a training session for you. Securing your diabetes supplies is a job you’ll have the rest of your life; you may as well learn first-hand how to do it well.
One thing to consider with your pump insulin absorption woes, a tubed pump allows you to select from a wide variety of infusion sets. These various sets will allow you to experiment with different cannula length. You could even try out a steel cannula; many people report good results with a steel cannula.
By the way, I think the t:slim is an awesome system and its introducing its hybrid closed loop tech, Control-IQ, in the next several weeks. Good luck with making your choice. Do your homework!
I’d give Tandem a call and tell them you are considering getting a pump from them. They will check into your coverage for you. Good luck!
Dave44 that is a great suggestion. Makes life much easier for her and Mom. Nancy50
How old are you? If you are any older than say 14 I would consider it a good time for you to learn how to handle this insurance stuff now rather than when you are away from home as an adult where you won’t have anyone who knows what they are doing to rely on for assistance. My mom had me start making my own appointments and reordering my prescriptions as a teenager so I could learn how to do it for myself.
It’s possible that your endo could get you the T slim with a letter of medical necessity but it all depends on what the medicaid in your state has to say about it. All medicaid insurance is administered through an insurance company, that company has the final say on whatever thing you are attempting to get.
Do you go low a lot and can’t stop it from happening even with the Dexcom? The Basal IQ feature which turns off basal when predicted to go low currently available with the T slim and Dexcom G6 combo would be a reason for medical necessity.
Your parents should be taking care of the phone calls with Tandem. Regardless of whether or not you might “mess up”, the parent should be calling.
I will say even when I was a kid and doing most of the management side of my diabetes, my parents handled all the insurance stuff. The reality is insurance companies will only talk to the person holding the policy. There are many times when my husband has questions and I have to get on the phone to ok the changes. So unfortunately your Mom does need to handle this but I do suggest you listen in on these calls because Wow was I shocked when I fell their insurance!
That being said, I also suggest just calling Tandem, explain you are out of warranty using a Dexcom and wanting to make the switch. They should be able to handle this pretty easily.
Also with a tubed pump, there are many choices from an infusion set standpoint. Length of cannula, metal or Teflon, straight or angled. So many options. And if you go with Tandem (I absolutely love my IQ!) you can ask your trainer to bring all the different infusion set types so you can see what might be best.
Good luck and I am so sorry but insurance battles are never ending. But I have learned, you must keep fighting. They expect us to get frustrated and give up, but we can’t! They need to pay for what we need since we pay them every month for the coverage!
As someone that actually just made the switch from omnipod to a tubed pump (tslim x2 in my case) I would recommend going for the 43 inch long infusion sets to start with.
Why? Mainly because I had a lot of anxiety switching over and using the shorter ones but it went away when I switched to the longer sets.
The other suggestion I would make would be getting running belt like a flipbelt or some cloth like running belt that has no clip in the back to connect it together but does have pockets.
Again why?
Because it’s useful in my opinion for storing the pump inside the little pockets that way if you tend rollover or anything you won’t worry about the pump so much.