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phil413
12-10-2007, 11:56 AM
Has anyone worked with United Healthcare to get approval for the Omnipod. I am just starting the process today but have heard that Omnipod is not "preferred" through UHC.

Any thoughts on the best way to approach this are greatly appreciated!!
twodoor2
12-10-2007, 12:29 PM
Has anyone worked with United Healthcare to get approval for the Omnipod. I am just starting the process today but have heard that Omnipod is not "preferred" through UHC.

Any thoughts on the best way to approach this are greatly appreciated!!

Don't know about that, but I do know that UHC is one of the few insurance companies that pays for CGMS, so you're lucky in that respect!!
rmccully2000
12-10-2007, 06:59 PM
Don't know about that, but I do know that UHC is one of the few insurance companies that pays for CGMS, so you're lucky in that respect!!

AMEN to that :) They did cover our Dexcom and we won GAP approval for in-network coverage so we only pay 10% coinsurance for sensors which amounts to $24 per month. SWEET!!

Becky,
Mom to Mason, 7 Dexcom, Omnipod
phil413
12-10-2007, 11:20 PM
Becky,

So, you guys have UHC and the Omnipod. Did you have a hard time getting coverage for the Omnipod and what does the coverage look like?
rmccully2000
12-11-2007, 12:10 AM
It was very easy getting the out-of-network coverage. I think it took about 3 weeks from order time to delivery. Getting the authorization just took time, but it was hassle free for us.

Our policy for out-of-network may differ from your policy:
$500 deductible
70% coverage after the deductible is met.

$3000 out of pocket maximum.

We are still fighting for in-network coverage because there are no network providers for pods. If we win the coverage will be

$250 deductible
90% coverage after the deductible is met
$1000 out of pocket maximum

We started in August and I still haven't had to pay for the 30% yet. UHC just cut a check to Insulet but they haven't received it. I did pay upfront out of pocket for the extra PDM though ( I would HIGHLY recommend getting one to prevent disruption in pumping should you have PDM problems)

Retail Prices are:
The starter kit is $800 and the pods are $35 each. You get 3 months supply of pods at a time (3 boxes of 10 for every 72 hour pod changes or 5 boxes of 10 for every 48 hour pod changes).
The extra PDM is $300.

Hope this helps!
Becky,Mom to Mason, 7 Dexcom, Omnipod