My husband currently does manual injections many times a day but would love to start using the OmniPod. We are currently in the process of signing up for a new health care plan through the marketplace. Can anyone suggest healthcare companies or plans in Florida that are most OmniPod friendly? I have done a ton of research online and calling insolent as well as all of the insurance companies but nobody can give me definitive answers as to whether the pod will be covered and if so what the cost would be. I am very hesitant to sign up for a new health care plan before knowing the costs as the Omnipod was still extremely cost prohibitive with the “healthcare coverage” we received from our last health care plan made.
I am also very interested in what others are paying for Free Style strips and pods on other insurance companies.
We have BCBS Feds and pay $66.00 per month for the Freestyle strips (that is with the coupon). Then we pay around $210.00 every 3 months for pods (so about $70 per month) after insurance. So we are paying about $136.00 per month just for strips and pods (insulin is another $40.00 per month for Novalog). Just wondering if there is better insurance coverage somewhere else or if we are gettting good pricing. Great question and good timing JessK. Thank you.
I think you might want to try some other insurance plans. You might compare Kaiser plans with Cigna and a couple of others. What seems to have changed is that Insurance plans are now charging higher co pays and OOP costs , especially for durable Medical equipment. If you qualify for a supplement on the govt. exchanges it might help. I have Cigna , but I have a group plan , which despite high durable medical charges for the pumps, will cover prescriptions at a better rate than you are paying. You might also contact Mini pharmacy , where I purchase Freestyle test strips at 15$ a month.
What I would like to hear is why won't insurance plans tell you what they will pay for pumps so that we can comparison shop. This is a real run around . I wanted to see if they would tell me the rates for a variety of pumps and no one would give me an answer. This seems very hostile to diabetics. So maybe someone out there can tell us how to shop for costs of durable medical equipment on a comparative basis?
FreeStyle has a program, I think it's called Promise, where you'd only pay $15/month no matter what your insurance is as long as you have insurance. Contact them to get on this plan. https://www.freestylepromise.com
I totally agree about the runaround! United gave me pricing a few days ago, but then told me I had to buy from one of their select companies, none of which supply the OmniPod, so I don’t think the CSR really knew what she was taking about.
Thanks for sharing!
This must be the plan I have...Although I did have to switch to Mini Pharmacy to get this rate. I wish the pump companies had similar discounts.
Best option - call Omnipod and ask for rep from your area to contact you. Ask the rep for advice. They deal with all the local plans and can pinpoint the one most feasible in regards to the Omnipod. Good Luck.
When I complained about this to my insurance company, They said I should contact Insulet, Minimed, Dexcom directly and ask them to find out the cost with insurance companies. Apparently the rates vary according to the contract of each insurance company.
Another option I got was to have my endocrinologist prescribe a different pump, then they could run the "codes" and tell me the cost.
This was ridiculous. Very unfair to diabetic consumers. Plans with low deductibles /OOP costs are VERY expensive for individuals. I am furious with the entire process...I think it is another way for those of us with preexisting conditions to pay more for insurance or reduce the level of our care.
I hope someone out there has found a way to deal with this.
I tried that and she referred me to Omnipod sales number which was no help either. Wondering what pod costs are for others monthly from Aetna, United, Cigna, etc?
That seems consistent with what I was told. However, make the rep do their homework and get specific details, as they are working to make a sale. Make them determine the deductible as well as the OOP responsibility.
What this system won't do is allow you to compare a variety of products (Omni Pod vs Paradigm, vs Vgo, etc. ). This means that the patient has to call of of the companies individually, rather than have your insurance company simply tell you what they will pay for these items. And by the way , Insulet is the company that sells Omnipod.
Honestly, Insulet was the most helpful in helping me narrow down insurance companies but still could not answer my question as to cost. Apparently, each insurance company has different 3rd party companies they contract with in the state of Florida, so Insulet does not have access to specific benefits for my state.
the whole insurance thing is ridiculous if not deadly
sorry that's my opinion
JessK you really need to ask this question of people in your particular state as insurance & related laws vary state to state.
We all clearly need insurance...because the drug/medical equipment is extremely expensive . However, unless we go to a national insurance policy as other civilized countries have, we are at the mercy of the "market". Very clearly the insurance companies want to keep the profit margin . This is why I believe health care should not be a "for profit" process. This topic illustrates what happens when the profit margin is challenged.
I moved from civilized Canada, with national insurance to US to be able to finally get pump and sensor.
In Canada I could only dream about it.
I was fully employed with standard national insurance.
Here fully employed, on pump and sensor x years.
The grass is always greener on the other side of the hill :-)
Maybe it is a matter of context. When I was fully employed , I was fully covered after a small deductible payment for my Durable Medical supplies . After I retired, I had to take over the monthly cost that my employer had paid for me, AND the cost of insurance for those with a moderate income rose significantly; the cost for Durable Medical rose by thousands of dollars. When our ACA went into effect, the private insurance companies raised costs so that they could remain profitable after more low income people, and those with pre-existing conditions could finally be covered. So from my perspective things changed for the worse , financially. But I still believe that those without work, those who are poor, and those with pre-existing conditions should have health care.
I can still be on the pump...but now I have to pay much more for that coverage. I can go back to pens /injections and be fully covered. So this appears to be my choice here. I would prefer that pumps would be supported by our national coverage (medicare) and for Canadian coverage as well! :)
Yes, I realize insurance is state specific but are there state specific groups here?
If the insurance company can’t answer the specific question about Omnipod then they will cover it as durable medical equipment. Ask them what the rules are for DME. It is almost certain that they will require a statement of medical necessity, so your doctor must be prepared to supply that. If you are already on the Omnipod this would be no problem, but since your husband wants to change it may take a while to get approval, and it’s possible that they might refuse approval. (Refusing a customer already on Omnipod is a lot more difficult because that puts the insurer in the position of dictating a change in treatment.)
The marketplace is fairly standardized, so you should have no more and no less of the problems that other people have had. I’ve yet to hear of a case of refusal to cover Omnipod so long as the doctor agrees; the cases where there have been problems have been with Medicare because of the split responsibility for prescriptions (the claim has to be made against Medicare, not the prescription insurer).
You know the worst case cost - it’s your out-of-pocket maximum. In practice, however, it costs quite a lot less than that, but you have to chose the right level of plan (normally Gold or better). Gold plans in Oregon (I don’t know about FL) cost about half to two thirds of the OOP max - $3000 to $4000 total per year (plus the insurance premium of course).
It is not quite this simple. What the insurance companies will not tell you is how much they are contracted to pay for different pumps, so the consumer can compare. You have to work with Omnipod,Minimed, etc. all individually. No one will tell you "the" cost. It is very annoying. Not all devices are covered at the same price as Durable Medical . This makes me very suspicious about who is setting the costs.