I am switching to UMR Insurance with the UnitedHealthcare Choice Plus Network as of September 1. UMR seems to not know what end is up, and they could not tell me how to get Pods. Insulet said that UMR contracts with EdgePark, but Medco told me that Pods were "durable medical equipment" that would have to go through Liberty. When I looked up UMR's definition of "durable medical equipment" it covered wheelchairs and crutches, but nothing like the disposable Pod.
What I need to know is this: for those of you with UMR and UnitedHealthcare Choice Plus, from where do you send for your Pods? I know each plan is slightly different, but I cannot believe that Insulet is contracted with too many different suppliers. I am working by phone to try to figure this all out with the various suppliers, but no one can give me a straight answer. What have the rest of you who deal with UMR found?
I don't know about UMR, but what I worked out is that it comes down to money:
Some insurance companies class them as durable and some as medical supplies (like insulin). It all seems to depend on which causes us to pay most; Blue Cross Blue Shield of Oregon requires the distributor to bill them as durable, they pay 100% of diabetic supplies but only 70% after the deductible of durable medical equipment. Meanwhile apparently Medicare requires them to be billed as supplies and Medicare doesn't cover supplies.
Since it's the insurance company that chooses how to bill them, not you nor Insulet nor the distributor, they have to tell you which distributor to use (if they are different). Likewise Insulet has to supply through different distributors according to how the insurance company want the pods billed.
Thanks for the reply. I know you are right that it all comes down to money, and all insurance companies are out to get as much as they can. I finally learned that Edgepark is "in network" for my plan, so UMR should at least pay for SOME of the bill. Medicare, for me, is still a few years off, so I hope by that time they get their head together and will cover the Pods. I do not want to go to a tubed pump just because Minimed is OK with Medicare but other pumps like the Omnipod are not. Time will tell.
I have UMR and UnitedHealthcare PPO, and use Edgepark for my pod re-orders. My plan considers the pods as supplies, and charges me 20% after deductible. Hope this helps.
