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just got the call back from omni pod about ins.

Discussion in 'Parents of Children with Type 1' started by realsweety, Apr 24, 2008.

  1. realsweety

    realsweety Approved members

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    omni pod called me yesterday ,our ins.company finally got back to them.looks like 70/30 .that is way to much money for us to cover.allison doesnt want any of the other ones and I won't force her.the rep said that our ins.goes through another provider for dme supplies and its out of network.she said she has never heard of that before.I remember someone telling me that it was coverd under prostetic supplies ,asked her about that and she said its only durable medical equipment.she told me to have my husband call the ins.company and ask why they go through another company for DME supplies.I don't know how much that will help though but worth a try.I was in tears.I am so tired of being the "first at things" .she said this is the first time this has happened ,where a ins.company goes through another company for DME.I am sorry that I am rambling ,I am just upset .and trying to plan our next course of action.any advice?
     
  2. Seans Mom

    Seans Mom Approved members

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    I'm sorry hear that. I know our insurance uses 2 companies for DME. But since they are contracted through the insurance, they are in-network. Seems strange that the ins. co. chose the DME co. and then calls it out-of-network.:confused: Saxmaniac posted about having the omnipod covered under prosthetic devices on his insurance. I don't know what to say that could help, but I just found your post on the 2nd page and thought it should be bumped up in case someone else has been through this and can help.
     
  3. thebestnest5

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    I am sorry. It is so frustrating to hear things like that. I know it's more to do; but maybe you could request in network coverage with the pod, by sending a letter and getting a letter of medical necessity from you Endo. I have heard of insurance companies giving in network coverage for some items when it's requested. I've sent our HMO letters, e-mails, faxes, calls...it has usually worked out to my benefit. But, I understand where you are coming from...every time I have to send another letter--it just seems like so much more work than it should be.:cwds:

    I hope you get the in network coverage.
     
  4. realsweety

    realsweety Approved members

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    thank you for the advice.the rep told me that the company that our ins picked for DME does not have a contract with them.maybe your right ,call the ins.company and see if it could be in-network.I would do it but I don't know ins. lingo very well (lol) my husband doesnt want me to handle the ins. company ,he wants to do it.male pride thing or something.plus he seems to like fighting with the ins. company lol.since he works till late I have no idea when he will get the time to call them.so it might be awhile before anything else happens.as if 6 months of doing research and pump classes wasnt enough.
     
  5. Seans Mom

    Seans Mom Approved members

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    I actually think it's a good idea for your husband to make the call. Unfortunately, it's my experience that when I do the calling, alot of times I get the run around. I end up on the phone w/ this person then that person and etc.. etc... arguing and telling them enough running me around just get me an answer and blah, blah till I'm at my wits end, frustrated and still nothing accomplished. Then I let my husband know what's going on...... he gets on the phone, w/ all the patience in the world (something I don't have) and calmly in his "low very serious" voice gets things done. I end up more frustrated for awhile because we (my husband and I) start out a call basically the same way (I don't have his "low very serious" voice) and I get the run around and he gets answers. KWIM? I hope he can get it figured out for your daughter to get the pump she wants, if not I saw your daughter is 4, my son is 4 also and on the Animas, he loves it, we love it. We thought we wanted the omnipod at first also because of the tubeless feature but the tubing has really been no problem at all. Of course our decision for the Animas was ours not because of insurance, and I know that makes a difference as well. ;)
     
  6. Daniel's Mom 1993

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    I feel your pain, I am in the process of appealing to get in network coverage. We have United Healthcare and they also said out of network which for us is 60/40 but I went ahead and ordered and even at that the did not cover a large portion of the pods(only covered $160 of $1380???) said it was more than the usual and customary charges for our area. I appealled with them and it was denied now I am appealling with my company as we are actually self insured so they have the final say. I have a great letter I got from another parent on this forum that the Omnipod rep said it was the best she ever saw. I would be glad to email it to you if you need it.
     
  7. realsweety

    realsweety Approved members

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    I sooo know what you mean about the deep serious voice and meanwhile I get circles.I think guys get a kick out of it when they're voice gets answers.I think that works plus he must know what questions to ask.he definately takes pride in "getting things done"with any kind of bill or insurance company.he is taking tommorrow off just for this fight.I know hes doing it to make allison and me happy.he doesnt like taking off of work.wish him luck
     

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