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No Omnipod for us

Discussion in 'Parents of Children with Type 1' started by LoveMyHounds, Mar 27, 2012.

  1. LoveMyHounds

    LoveMyHounds Approved members

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    My daughter has MassHealth (this is the state health insurance). We applied for Omnipod and I just got the message,that MassHealth will not pay for anything!
    The PDM is $1,250 and 1 box of pods is $300. I was told she needs 1.5 boxes per month. We cannot afford this! I sit and cry. It's like being diagnosed again.
    Do you have any ideas? Are there any programs that help people like us?
    Please help.....
    :(:(:(
     
  2. miss_behave

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    Is the OmniPod the only pump they won't cover? Have you looked into other pumps?
     
  3. LoveMyHounds

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    This is the only pump my DD would consider.
     
  4. Ndiggs

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    Childrens Special Health in Mi is the same way, they cover medtronic and animus pumps but not Omnipod. You may want to check and see if one of the other two are covered. What I was able to find on their site shows they do cover pumps, so I would follow up again to find out what ones.
     
  5. Eminemsmom

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    An option?

    I thought I read a post somwhere that the insurance company would not pay for the pump, but the pods would be covered under durable medical. I may be way off- does anyone else remember seeing this?
     
  6. KatieSue

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    Our pods are covered under durable medical.
     
  7. malyssa

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    What about going through another supplier, like edgepark? This is what I do. I have BCBS and they gave me the most difficult time in getting pods covered, and told me I'd have to pay full price. So when I called edgepark, they gave me specific instruction on how my endo had to write out the rx, and by ordering pods through edgepark, my supplies are covered 100%. It's worth a try. Good luck! :)
     
  8. LoveMyHounds

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  9. LoveMyHounds

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    Sorry, I didn't read to the end. But why would they cover something they don't want to pay for somewhere else for less $$?
     
  10. caspi

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    I know I have read of other state insurance programs that haven't covered the Omnipod, and I also believe that Medicare won't cover it for seniors, but I also read that it had something to do with how it was being billed.

    Your best bet would be to call Omnipod directly. Considering they are based in MA, they should have the correct information.

    Good luck.
     
  11. 3kidlets

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    What is the deal with Edge Park? Or insurance just changed from Aetna to United HC. I got a call yesterday from OmniPOd because they were getting ready to refill Hana's PODs. They noticed that we were no longer covered by Aetna and said that they do not have a contract with United, therefore, we would have to get our PODs from Edge Park going forward. When I googled Edge Park, there were many many negative reviews. No one had anything good to say about them. Multiple reviews said that there was a 60% markup on the PODS! Why the heck would United prefer to work with them as opposed to Insulet (OmniPod) directly? I'm really nervous about this change. From what I read, dealing with EdgePark is a nightmare. It is fine if you have a straight forward order, but if there is a problem it is outrageous dealign with them!
     
  12. mmgirls

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    I have never had a problem with Edgepark, we have to order dexcom thru them. Maybe people are talking about the listed internet costs, but those are not the insurance contracted costs. They are timely and are very easy to order from and search their site for other things. We also have united.
     
  13. betty6333

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    I am sorry to hear that! My son loves the omnipod. I hope you can find a way to get it covered.

    If not, the ping is a great pump! Had he not be able to use the pod, the ping was our second choice... And it has a remote ... At night it is wonderful not to have to disturb your child to give insulin!
     
  14. caspi

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    With our old insurance, we used Edgepark as well and never had any issues at all. They were always very courteous and knowledgable whenever I spoke with a customer service person. And I agree with a PP that the cost you see is not the insurance negotiated cost.
     
  15. 3kidlets

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    Thanks! That's a relief to hear.
     
  16. LoveMyHounds

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    I did. And the "no"answer got from them:(
    They are 30 minutes away, but obviously being the neighbor won't get you a better deal ;).
     
  17. caspi

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    Ugh, I'm so sorry - that just plain stinks. :(
     
  18. obtainedmist

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    I would try to advocate for a different pump and ask your daughter if she would reconsider the others out there.
     
  19. MomofSweetOne

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    I know it won't help NOW, but our rep told us that Medtronic has a tubeless pump in the works, so maybe someday, there will be a tubeless pump that more companies will allow.
     
  20. MommaKat

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    Initially my dd would only consider omnipod - she's a swimmer and it made sense. State health insurance won't cover it here either. 3 months later, once we were up to 8 shots a day, dd decided to research the other two pumps. We had insulin start today.

    Back when we first looked at pumps and thought omni would be a possibility, she ordered a trial pod. So glad we did that - she hated the feel and the adhesive made her break out. Fast forward three months, she trialed insets from both animas and medtronic, having the least issue with silhouette.

    While today has sucked in terms of severe lows, we can tell she's going to love the pump, and the benefits she thought she'd get from tubeless aren't such a big deal anymore - she thinks most ended up being untrue. Obviously just our experience, but I share it b/c dd started out so anti pump, then omni only, and is now rather happily pumping with medtronic.

    Give her some time, and let her explore some options down the road. She may open up to some other options on her own.
     

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