After researching insulin pumps, sampling and trying to decide which pump fits into my life the best, I decided on the Omni Pod. I tried the dummy pump and absolutely loved it. I took all the crash courses on their website and I am so excited to start on it. Then I heard the brakes squeal in my brain and realized there is one problem...INSURANCE COVERAGE.
I called my insurance rep and she said that the Pod is not considered a "formulated prescription" (I think that was the term she used--correct me if I'm wrong!). So they will not cover it. DARN IT!! WHY NOT?!?!? She said that the only chance I have is to have my doctor fill out a narrative on why I need it and how it will be a success for me THEN, they may or may not cover it. The rep said that she had seen it go both ways, but there is no way to predict it.
Everything with the Omnipod is perfect for my lifestyle--I am a watersports person, a snowmobiler, a horseback rider, a motorcyler, and a 'tosser-turner' when I sleep. The Pod JUST WORKS for me. I just got diagnosed with T1 this past October and I have been striving to make my life a little more like it was...and getting the Pod would definately help with that. Ok....getting a bit dramatic here, but you know what I mean.
My question is....has anyone had this same problem? Did your doctor's narrative work? HELP PLEASE!!!
You guys rock and I ALWAYS appreciate your input and advice...I appreciate it. Take care.
I had the same problem. The OmniPod was the ONLY pump I would consider and unfortunately my insurance company wouldn't cover it. It was a hard road. I had to fight with them for like 3 months but in the end I won! If they deny you file an appeal! That's what I had to do. I had my endo fill out a medical neccesity form and I also had her write up a personal letter explaining WHY this was the only pump I could use. In my case, I work with exotic animals, mostly primates, and I could not have a pump with tubing because they could get to the tubing and pull it out whereas with the pods I hide them under my clothes. BE PERSISTANT! They will most likely deny you because of course this is America and our insurance companies suck. Just keep insisting you HAVE to have it in order to be healthy. I had a co-pay of $600 for my PDM and the first 3 month supplies of pods. Every 3 months I pay about $148 or so for pods. Good luck!
I have had the omnipod for 2 years now. My insurance does cover this pump. Blue Cross. The pump is great in the water. I have had no problems with it. I have had Juvenile Diabetes for 30 years.
Had the very same problem, and had to have a doctor write a "narrative" and letter of medical necessity. Hang in there, keep appealing, and also - consider other options. I was on the OmniPod for 2 years before I had to switch off of it back to the MiniMed (tubing) because it was not nearly as effective or accurate as the hard wired pumps are.
I agree that the omni is not nearly as effective as the hard wired. Met a lot of people with keytones on it. Stick with the Minimed. But Back to the issue, Harvard Pilgrim is AMAZING!! Covers everything!
This should not be a new issue for your doctor. It is pretty common for insurance's first reaction to 'deny'. Then doctor writes letter. May or may not deny. If deny, you appeal - doctor might have to submit more paperwork, etc. Keep pushing. The squeaky wheel gets the grease! This also is not new to Omnipod - so use your sales rep and their team to help push the insurance company. They will do it because it is to their advantage to have another insurance company decide to cover it for all their patients.
I never had to deal with ANY insurance stuff prior to my son's dx. It seems challenging partly because it is new (and intuitively shouldn't be this hard!) That doesn't make it any less of a pain in the butt, but just that it is another thing you will get used to because of D.
Hang in there - you sound like the type of person who will not take NO for an answer, so use that your advantage! You go girl!