Pump Help... :(

I am having issues with getting a new pump. I got the Omnipod pump in Feb. of 2009 and found in may that I did not like it. Im a hairstylist and it just always seem to be in the way and just uncomfortable. I also have bruises where i have put the pump that have been their for about 4 months that still hasnt gone away. It just did not work out for me. I have signed up to get the Paradigm Real-Time Insulin Pump and Continuous Glucose Monitoring System. My insurance has approved me of the Monitoring system but not the pump?? They say that i need to speak with Omnipod to get apporved for the pump. I purchased the Omnipod with my OLD insurance and at the end of may started on a whole new insurace. My BM told me they could not move on until i spoke with Omnipod because i have not even used/ have had it a full year. I spoke with Omnipod and they said its past the 45 days to return it, but even if i could have returned it the refund wouldn’t even be going to the insurance company im using now, so i dont understand why my current insurance compay needs to even worry about the Omnipod. Omnipod was very confused when i told them im under a whole new insurance and had nothing to tell me. They said there was nothing they could do. Im honestly just left sitting here with confusion, frustration and pain. I don’t get how a medical device that is so needed can be so hard to get. This may be all confusing to understand, it def. is for me. But if anyone has any similar stories or suggestions that could help me out, itd be awesome. Im just so lost… and these are the times you get so down, you just wonder why it was me that got this disease. Please help…thank you.

What are you saying Dave, that after our 4 year warranty is over we don’t
automatically qualify for a new pump, from our insurance.

see this all just confuses me. The omnipod doesn’t work right with my body, sometimes it works other days it doesnt, it causes bruises all over me that still have not seemed to go away and never stays on. Also my actual meter/pump monitor that control the pod no longer works.This pump is just not working with me at all but I am so sensitive to insulin i NEED a pump. I have way to many lows but than always have to many highs. I even use a half a unit insulin pen, that still seems to not do the work. That extra half a unit may be to much but than when i take that extra half unit off its not enough. Im under all new insurance now, not that same one that i received my Omnipod with. Im just so very confused and lost…

Ray for me thats what happened I am disabled and on medicare they refused to upgrade me until i had my pump 5yrs. and yes i went 1 yr without warrenty, but nothing i did or pleaded helped .Those are the rules and that is that…on strips they allow you 4 strips per day and if you need more you must proof your need…i told them i am on a pump is’nt that proof enough. nope it is not… I have to send a log and the Dr. has to send my info from my pump to compare i guess… Its very frustrating…Like if i am a lier or something its bad enough to be ill but to be made feel like a criminal is terrible…And Heather I know your frustation first hand … Good Luck with the insurance companies and please come in here and vent don’t keep all your troubles to yourself because stress is terrible ob the bgs…God Bless…write to me anytime you want …

Yes and ive talked to Omnipod im passed to the 45 days to return it, so i cant do that. I think pretty much at this point, no hope in a new pump : (… Thank u both though. and yes the stress def isnt good on my bg at all. ahh, all ive done today is cry. How ridiculious this is to get a medical device that is needed and it just seems like theres no end to the complications and frusterations. I dealt with crap at the pharamcy the other day, and had to call all over to get prescriptions filled and what not.When that kind of stuff you should be able to walk in and pick up an hour later… blahh

If you are interested in a MM pump, I would contact the rep over your area and ask them to see if they can get you a deal like they did for the cozmo pumpers.

If they won’t help, try animas. I know they had a trade in deal for the cozmo users too. Both of those are tubed pumps which will have a site that is smaller, but in turn you will need to keep the pump in a pocket or on a pair of pants, or a pouch of some sort.

Have you filed an appeal with the insurance company? many times they say no to everyone, and you can get it over ridden with an appeal.

I have worn the pod, and my son wears the pod, and we have never had bruises, so that would be hard I can imagine! I find sites that are out of the way to be the best.

If they are saying that they will approve a new pump in a year, then you can wait the year, and then apply for the pump you would like.

Have you had the dr look at the bruises that are still around 4 months after you got them? assuming you are rotating sites, I would be very concerned that there is an underlying medical condition if you have a bruise that is still there, four months later. If he can identify the underlying reason you still have bruises after 4 months of not re-injuring an area, he could add that to the appeal. With site rotation this has never been an issue for us, but it seems to be one for you. I am sure you are not using the areas that are sore, so I hope that they begin to feel better soon. That would be scary to have a bruise for that long and not have it heal.
Until you can get the new pump, try lots of new sites. I like the leg, thigh, back, and arms. My son likes tummy, but I find it uncomfortable, but every one is different!

Good luck on your appeal to the insurance company! In the mean time, enjoy your new CGM! The MM CGM works well for some people, and I hope you will enjoy that ! Few people get insurance coverage for it at all!

Ok some things to clarify with the insurance. I assume you work for the same employer or that the insurance is with the same employer. Remember the plan is with the employer, even if the same employer has ten insurance companies in a row, they are still administering the same basic plan and plan year and that plan and plan year will not start with a new insurer. Lets say for instance that you work for an employer and they switch providers. Likely, they carried over your deductibles form one plan to another. In fact they may have even given a maximum credit for plan use, that is uncommon but it does happen. now even if they started things all over and said deductibles go back to zero, you are still in a plan. That plan will govern how such issues will be decided. In short, get the plan documents and read them cover to cover. If you do nto understand it go to personnel and ask for an explanation. Only if you push will you find the final answer.

now, lets say the insurance is with a new employer, you will need to work on understanding the new plan. Many new plans have a qualification that looks back on medical devices.

Ok, so that explains why you are having difficulty. Now lets consider what to do. First get your doctor to write a letter that says the omnipod does not and will not work as a result of insulin load, ie…daily dose. Also add in that your skin is being damaged as a result of scaring and you are running out of insertion sites. None of this will turn the argument on its own, but there may be a sum of the evidence that points to changing.

My guess is that you are stuck, but that does not mean you should throw in the towel. i know you already have a job. unfortunately, you just got another one.

rick phillips

Great idea…call MM and ask for a comparable deal.

hey- i have the omnipod, so i can relate to the uncomfortableness of having it around. sorry it didnt work out.

Doesn’t health insurance suck??? They will find ANY loophole to make your life miserable, and that totally sucks. I hope that it all gets sorted out.

Plus, my hairstylist is pregnant, so if you think a pod gets in the way, try having a baby in the way. (kinda weird…)