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Medicaid as new secondary insurance and new pump?

Discussion in 'Insulin Pumps' started by Allyson244, Aug 16, 2014.

  1. Allyson244

    Allyson244 New Member

    Joined:
    Aug 16, 2014
    Messages:
    2
    Hello! Long time lurker, but this is my first post. We've been playing the insulin game since 2001 when my oldest son was DX'd at age 7. He switched to a pump at 9. (MM 512, 522, 723) Just to add to the fun around here, my special needs daughter (18p- syndrome, autism, developmentally delayed) was DX'd in March of this year. She got the Omnipod last month. It is working well for us so far, but I keep having a nagging feeling that we should have a back up tubed pump around just in case. In case of what? I have no idea, but still the feeling is there.

    DD was just approved for Medicaid on July 1st as a secondary insurance in PA under PA-95. (Some call it the PA Loophole). Her Medicaid did not cover any toward the purchase of the Omnipod start up stuff, nor does it cover any toward the cost of the Pods. Our primary insurance (Tricare Prime Retiree) covered 80%.

    So, my question is: would Medicaid cover a tubed pump for her since it was not involved in the Omnipod purchase?

    Allison
     
  2. vgage03

    vgage03 Approved members

    Joined:
    Oct 1, 2014
    Messages:
    8
    Talk to your child's doctor first. They are a huge help when getting things approved from Medicaid. In my state Medicaid covered 100% of my sons insulin pump. I am pretty sure they would also cover the omnipod. In a majority of cases Medicaid takes a few extra steps when getting supplies approved. That is where your doctor comes in handy. We had to have a prior authorization and they required a months worth of blood sugars. I would suggest talking to a diabetic supply center that is approved by your Medicaid and have your doctor send an order for a pump to them. They will contact Medicaid and let you know if there will be additional steps that need to be taken. If they don't approve it then at least you tried. I have learned that some pharmacies will bill insurance under the wrong codes causing items to be declined. If its possible I would try using a different supplier than you used the first time.
     
  3. Allyson244

    Allyson244 New Member

    Joined:
    Aug 16, 2014
    Messages:
    2
    Thanks for the reply! I think we have got it worked out with Insulet, Tricare and her medicaid. :smile:
     

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