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Aetna and Omnipod coverage

Discussion in 'Parents of Children with Type 1' started by Lorraine, Nov 25, 2008.

  1. Lorraine

    Lorraine Approved members

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    Saw a thread about a year ago..but want to get the latest experiences from folks who have Aetna insurance.

    Caleb (5) is on the Omnipod. I am being told (not sure how reliable) that Aetna covers the Omnipod under the DME component of the policy. In our case, that has a $2500 per year cap. We are currently with Cigna which covers 100% without any cap as they are treated as a diabetic supply

    Can anyone with Aetna please provide some info on your pump coverage -both Omnipod and non-omnipod?

    I cant figure out how anyone could afford a pump with a 2500 cap, omnipod or not.

    Thanks in advance!
     
  2. CatiesDad

    CatiesDad Approved members

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    we had CIGNA last year when we went through the battle to get coverage for the Omnipod. We were denied twice and finally went through 2 appeals and they agreed to cover. Apparently they did not have a signed contract with Insulet...whatever.

    Anyway, my plan covered 100% but had a $2500 DME cap. As a result we had a $400 or so bill charged to us at the end of the year as our last shipment brought us over the max.

    Thankfully this year my company switched to Aetna...they cover 100%, also out of DME but the annual max is $10,000. Obviously we are much happier with this.
     
  3. Jordansmom

    Jordansmom Approved members

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    Aetna has personalized plans for different employers, So everyone's policies here are going to be different. We have Aetna and were approved for the Omnipod at 80% with no cap on our DME. But we changed our mind before ordering and purchased an Animas Ping. Also at 80% as a DME. Pump supplies are the same. Because we had met our out of pocket maximum we did not have to pay our 20% this year.
     
  4. Lorraine

    Lorraine Approved members

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    Thanks for the replies. Was trying to understand whether they treated as DME or diabetic supplies. We unfortunately have a $2500 cap for any plan option with Aetna as opposed to our CIGNA plan last year which treated the pods as a Diabetic supply covered 100%.

    So far two consistent replies that its treated as DME.
     

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