Insurance and insulin pump

I have to say I’m not impressed with the guy that’s been trying to help me get this pump. I was in contact with him about two years ago about getting the pump. He told me several times that my pump was about to shipped and it was covered by the insurance only to find out it wasn’t. I feel like he’s a bull shitter and he doesn’t care about my health. He just wants to sell the product. Last week he told me that I would have to pay $1400 out of pocket for the pump. It wasn’t until I told him my insurance should cover more than that, that he called me back and said I would only have to pay $68. After that he told me that the pump was being shipped that same day. A few hours later he called and said they couldn’t ship it out because it needed more verification from the insurance company. He said he was going to call me Friday with the status of everything but I never heard from him. Hopefully I hear from him tomorrow. I also go to my endo tomorrow so maybe she can help me. I’m so tired of being on injections. Insulin pumps are much more convenient. I should of never switched to the Omnipod. If I hadnt I’d still be on a pump now.

I wish you luck with your new pump if it ever arrives and at a price that you can afford. I’m happy that I didn’t go through the jumps & hoops that you are going through. When I decided [finally] that a pump was right for me, the endo put in a call and by the time I got home a Medtronic representative was on the phone asking me a few questions - the pump arrived a week or so later. What pump are you getting? I agree with you about the 1500 shots per year cutting back to an infusion set emplacement every third day is a BIG incentive.

Seeing that you have previously pumped, you know that just because your are pumping that you can just sit back and let that little computer do everything for you. Setting and adjusting basal rates for different times of day, carb:insulin ratios for meals [my carb ratios differ significantly between breakfast and supper], and of your course insulin sensitivity factor to help the pump better calculate bolus adjustments.

If you need help calculating and validating the rats for you, ask for assistance. There are good charts and guidelines [I have copies] to help you with this task. A word of advice from an old-timer, be patient with yourself - there will be frustration at times. And most of all, enjoy life!

I’ve always worked with Minimed, and it’s been pretty straightforward. The only surprise I had when I recently upgraded mine is that they didn’t factor in the deductible I still needed to fulfill, but they wouldn’t have known that.

If they haven’t shipped it yet, you can probably change your mind and cancel the order if that’s what you want to do. Otherwise, a call to your insurance company directly might do the trick, because they don’t want to pay anymore than they have to, but they want you to get the full benefit that is coming to you and can often act as a mediator.

I’m looking at the Medtronic pump that suspends insulin delivery when your blood sugar goes below a certain level. I think it’s the 530 or 560? I can’t remember which it is. The only thing I’m worried about is that the last pump I had is still under warranty until November. I’m afraid that might be a problem with the insurance company.

I can’t offer any other advice, but I agree that the ‘sales’ department over at MiniMed has slowly slipped downhill over the last 15 years. The representative for my area drug her feet for 6 weeks, and in that time, I changed insurance and had to fight with MiniMed to bill correctly for the date I ordered my new pump. Ugh. Good thing I’ve got 30 years of cajoling and threatening and fighting with the MD coverage laws in hand. It’s tiring, but so worth it. I hear Animas has a nice pump, square wave over 15 min increments, which I truly miss in my paradigm.

I’ve seen one of your other posts about chasing highs and DKA. I’ve been a t1 for 49 years (I was diagnosed at 10 mos). If you want to chat, send me an PM. I’m only happy to share what I’ve gone through and let you use the lessons I’ve learned.

Best of luck!

Hi There!

I have had my fair share of struggles over the last couple years with insurance and pumps! Insurance companies have gotten MUCH more strict on what they cover. how much., and how often. That being said my switch to Omnipod (Insulet) has been the best thing ever! My insurance company a the time denied it. My pump rep & the RN pump trainer they assigned me have fought ever battle and hurdle for me. I ended up ordering my pods as a prescription instead of durable medical equipment. I did have to buy the PDM as very very few insurance companies will cover it. I was fine with that. Having been on Omnipod for 6 months or so now, I NEVER want to go back to a pump with a tube. I wish I had switched sooner. My rep & trainer continue to be available to me anytime I need them.
Just yesterday I learned my new insurance company (new job recently) is denying my pods & strips (the freestyle meter is a part of the Omnipod PDM) so I have yet again turned to my omnipod warriors who will fight the battle for me to get my supplies covered. I don’t know what state you live in but if I where you, I would call the main Insulet # 1800-591-3455 and talk to customer care there about your account and the rep that handles it, maybe there is another one near by. I have had nothing but an excellent experience with the whole Insulet company including customer care at the very beginning!
I have in the past had both medtronic and accu-check pumps and I would never go back. Nothing comes close to the Ominpod pump or the Insulet company’s standards for customer service. If the Rep is not treating you right, you need to call. I wish you the best of luck and hope you are back on a pump very soon!!!