OMNIPOD and UNITED HEALTHCARE

[phil413]

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!!

[rmccully2000]

UHC covered our Omnipod at the out-of-network benefits 30% coinsurance after deductible. I applied for GAP in-network coverage and was denied because they said I could use a network provider (MM or Cozmo).

I paid $300 for the backup PDM (insurance doesn't cover this at all) plus
$240 for the startup kit and
$515 for 50 pods (a 3 month supply if changing every 48 hours but that shipment has lasted 4 months)

I appealled this decision due to the fact that neither network provider offers a tubeless pump, which is a new type of insulin delivery system. I attached a study by Insulet citing the saftey aspect of a tubeless pump that doesn't need to be disconnected. I'm still waiting to hear the results of my appeal.


We love our Omnipod!
Best of luck,
Becky, Mom to Mason, 7 Dexcom, Omnipod

[KTurner52]

Just something else to consider with insurance and the Omnipod..the PDM uses Freestyle test strips so make sure they will cover those. I didn't do that so consequently, our pods are covered at a 20% copay, but the strips only at 50%, so strips are setting us back $132 a month. I have appealed but am just getting ignored. Actually, no one "gets" why we just can't use a preferred meter/test strip, or they just don't care.
**Regardless, Omnipod is a great system.
Kelli

[akrickard]

UHC approved us at 100% coverage, but my policy may be different than yours. I'm a civil servant, and our group is huge.

[phil413]

So, I wanted to update our situation and see if you had any advice.

UHC did approve my GAP in-network coverage. However, they are covering the PDM and PODS as DME, which has a lifetime max of $10000. So, she could have the pump for a little over a year and then we would have to pay 100%.

Needless to say, I am NOT a happy camper.

Did this happen to you?