Omnipod and UHC

[Daniel's Mom 1993]

I have our Omnipod and the pump start is scheduled for 4/17/08 but United Healthcare has me nervous - I knew it would be out of network and I am appealing but it was processed yesterday and they did not cover $1220.00 of the $1380.00 charged for the pods - they said the cost was above the reasonable amount for similar products or healthcare. I think they are comparing them too sets for traditional pump. I called Insulet but because they have not received the EOB or payment yet they said to call back next week so they could check on it when they have the info in front of them - that is fine but I am worried that if we go ahead with the start and things don't go well how do I take it away from him? He is so excited about the pump start. Did anyone else have this happen - I know I have read several who were covered out of network and some whose GAP exceptions were approved. I will be happy at this point just to know it would be covered Out of network.

[saxmaniac]

Sorry, I can't help too much, but knowing the coverage rate before we picked was a major factor - no way we could really afford the pod at retail rates.

Somehow they are missing the part that they don't have to pay $6000 for the pump itself, which they'd have to replace every 5 years or so anyway. Sounds like you might need to appeal this.

[twodoor2]

That's a pity, but that being said, I do think UHC is one of the few insurance companies that actually covers CGMS. I hope you appeal and it works. Definitely mention the fact that they don't have to pay so much for the pump up front.