I posted a message a couple of weeks ago about Insulet and UHC and several of you said that you’d had no trouble getting pods, etc., covered going through EdgePark.
Well, in my case that’s true. Everything is covered. There was a glitch because I didn’t hear anything from EdgePark as Insulet had told me, but when I called EdgePark directly they set up an account immediately and sent the paperwork for prescriptions to my diabetes educator right away. All in all, a good experience.
My beef is with UHC itself. My employer switched to UHC on July 1 and we were told that everything we’d paid this calendar year toward our deductibles would roll over to UHC. Here we are, August 12, and no deductible shows up on my UHC account. EdgePark won’t send me pods unless I pay the entire cost (completely understandable!).
When we first switched to UHC, I had a heckuva time getting into their system. Even into the second week of July, I didn’t show up in the UHC system – whether UHC was looking or a provider was looking. I fought hard to get everything set up correctly so my office visits and prescriptions would be covered. When our HR person was on vacation, I even contacted the sales rep who sold my company the policy!
What horrible customer “service”. UHC absolutely sucks.
I called HR and they are contacting our sales rep to get the ball rolling. Why is it that a patient has to figure out that things aren’t set up correctly? Wouldn’t you think that there would be some kind of QC at UHC?
Of course my biggest fear is not getting this straightened out in time for my next shipment of pods. EdgePark was ready to ship today – but I couldn’t afford the $640. I have two pods left and the one I’m wearing expires tomorrow. Going back to MDI isn’t the worst thing in the world but it makes me mad that I might have to go that route since I’ve been working to get the insurance straightened out for over a month!
I guess I could shell out $160 for one box of pods while I wait for the dust to settle. . . . but I’m frustrated and angry about this whole situation.
If you call your Insulet rep and discuss this problem with her she may be able to leave a few pods at your Endo’s office for you. It never hurts to ask. My rep did this for me when I lost a few pods on my first order simple through my own fault (knocked them off, put them in places with bad absorption, realized that my pods were only lasting me 2 days but my prescription was for a change every 3 days.). I hope you get this settled and are able to avoid MDI’s!
My mom worked at UHC for 8 years and considers them the devil incarnate. She used to tell customers not to take no for an answer and to just keep appealing until they got what they deserved. The system (forgive our cynicism) is designed to discourage you until you stop trying. I think right now, you need to shell out what you are able to to get what you need self-pay style, but then, I would re-submit every last claim until I got back what they should have paid. Someone should be liable for the promise that the deductible would carry over.
People in the insurance company and doctors have both told me that pump supplies are billed to the company as just that “pump supplies” so if you needed to switch to another pump you would have to pay for the pump unit but the insurance company would not know the difference between Insulet, Animas, or Medtronic pump supplies. If your insurance paid for the PDM then they have approved you for an insulin pump and should be paying for your supplies. Make sure you fight this battle because it’s one you should be able to win.
UPDATE: As of yesterday, this still hasn’t been resolved. I’m so angry! At first, the UHC rep who could help was on vacation so I had to wait until this past Monday. Then I followed up every single day and my deductible STILL isn’t in the system.
The UHC rep has been polite and helpful but I can tell that she has no authority. All she can do is to beg others to get the system updated. I know she was trying to be helpful, but when she suggested that I just buy some pods locally . . . . it piled on to the “you just don’t get it” frustrations that I already have. Why do I have to beg to get the coverage that started almost two months ago? I told them I’m diabetic only because I thought it might expedite things. Wrong.
Then, she suggested that I “just” charge the $640 to my credit card and wait for UHC to reimburse me. I didn’t lose it but I was close. I don’t have that much credit available, which isn’t her business. And wait for UHC to reimburse me? Are you KIDDING? Two months’ worth of premiums paid and I can’t get what should be a routine prescription processed. Maybe if you pay me interest while I wait for reimbursement. How about 20% per month?
Instead of losing my temper and letting that poor UHC rep have it (knowing that none of this is her fault), I sent a polite e-mail outlining my frustrations and pointing out that I easily have 20 hours into working with UHC just to get covered in the first place and then to get my deductibles straightened out. That’s just shy of 3 hours for each week of coverage. Doesn’t that seem a tad excessive?
Man, I needed to vent. AGAIN. Thanks for listening. And thanks for the great suggestions, too. I contacted my diabetes educator and she gave me three pods to tide me over. Looks like I’ll have to contact my Insulet rep, too, the way things are going.
Did anyone say how the deductable was going to be entered? I switched insurance companies in the middle of the year once, and I think “all” I had to do was send a copy of an expanation of benefits from the prior company showing that the deductable was fulfilled. If you have any energy left to make yet another call, maybe this can help. Brad
Brad, thanks for understanding that I might not have the energy to make another call.
The deductibles were supposed to have been entered automatically but once I figured out that that hadn’t happened, I went to my old insurance company’s website and printed out a page showing that I’d met the deductible. It took them over a week to enter it anyway!
I finally got this straightened out by escalating it. Someone whose title is “Manager of Account Management” talked with me and got it fixed in 24 hours. Personally, I think that his title alone explains why there’s so much red tape and rigamarole!
