I have United Healthcare, and just found out that the prescriptions will now go through Optum RX. When I called to get set up on refilling my pod script, I found out that Optum does not carry pods, and they referred me to a company called North Coast Medical.
Anybody have experience with them?
Im afraid that now I'll have to pay towards my deductible since this is a 3rd party distributor. With Medco, the pods were just another script.
I hae UHC and have express scripts, but for pod supplies I use Edgepark medical. As long as they have the correct insurance info and they work with UHC, nothing should change for you. Give North Coast Medical a call and they should be able to verify what you will be paying.
Yeah the reason I got my pods through express scripts/ medco, is that the deductible didn't apply, they were a regular script. If I used Edgepark I was going to be subject to the $1000 deductible. Just anxious to see if the same thing happens with this new company.
Had the same thing happen to me earlier this year. Medco was a rarity in that they considered the pods to be medication. Optum, unfortunately does not so you'll be relegated to a third party distributor who will classify the pods as DME. I use Edgepark and they have been great in terms of customer service and shipping. But the days of a $175.00 copay for three months of pods are gone for us. At least your deductible is only $1K. Mine's $3K which means I'll be paying list price from now on.
Did you check with this "north coast medical/ advanced diabetes supply" that Optum suggested? This may actually cause me to have to go back to MDI..I NEVER cover any of my deductible since I dont get sick. Frustrated beyond words right now
I got that letter so I called my insurance as well as Edgepark for CGM and Insulet for Omnipods. They said that those items do not go through pharmacy benefits, they go through regular claims. The medco change to optum-rx will not affect my CGM and my pods. Hope that helps.
We will see...this North coast place is supposed to be verifying all this. I hope it doesn't cause me to go back to MDI cause of the deductible. From what I remember, pods are around 300 per box retail
Edgepark is NOT a good company to deal with. When I first contacted Insulet re the Pod, I got a phone call from a local sales rep who was encouraging, said that the online application was all I needed to do, she would even get the approval from my Endo and I would be set to go. I got an email (thank God, I save all emails re costings) and it said the 'your insurance requires you to use an approved vendor: Edgepark, and they would be contacting me. Sales rep called to congratulate me and say that 'Kenny Moore' was my contact at Edgepark. I insisted orally and by email that I have confirmation of coverage and at what level of co-pay. Kenny sent me an email with verification and rates. I sent money, got PDM and Pods. Very happy until reorder a month later when Edgepark promised delivery and they didn't arrive. Finally they said it was an 'insurance problem'. Called my insurance company and the said forget the (over) $900 billing from Edgepark, they never submitted the claims or authorization so it's their problem. Insurance company even found a source that wouldn't charge a co-pay. Happy, Happy, until last week when I again received the same bill from Edgepark. Called insurance company and they NOW say that Edgepark was NEVER authorized as a supplier, now it's all on me. I have forwarded the emails to Insulet stating their 'approval' of my insurance, recommending Edgepark, sales reps email with confirmations, Edgepark confirmation of benefits and no one will take reponsibilty for their failures. I guess a lawyer of some type is next. Any suggestions?? Don't use Edgepark.
Just an update, using this North Coast Medical/ Advanced Diabetes Supply...evidently the insurance was verified, and I will owe $60 per month (up to 2 boxes per month) We'll see if thats what really happens
So they're processing the pods as an RX and not DME?
Thats what they said... Thats how Medco/Express scripts did it...the pods were a normal script. Whats funny is they will only allow 1 month at a time...so obviously im going to get the doctor to write that I change every 2 days...
Just spoke with them. I owe you a debt of gratitude. I think you just saved me about $3K a year. THANKS!!!
Im like that…If you look back when I was trying to get the new PDM…Im not just going to take the first answer I get…
Waiting on my Dr to get a new script to them, had Dr change script to “every 2 days” so I can maximize how many pods I get. Its a no brainer…$60 for 1 box or 2…