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Ohio Medicaid a blessing and a curse.

Discussion in 'Parents of Children with Type 1' started by Judy&Alli, Sep 13, 2011.

  1. Melissata

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    The deal that we took over 2 years ago included the pods for a month. That was unreal and they probably stopped it shortly after. How are you guys liking the Omnipod Shannon?
     
  2. sammysmom

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    It is a work in progress. The IOB issue really is a safety hazard for Sam but we worked around it by setting higher targets and correct over --- # for the inbetween meal times at school. Sort of like setting up a fake IOB. So far so good! He likes it and to be honest, he is 10 yrs old and has had diabetes for 9 of those years, most of which has been spent on a pump. Tubeless is very refresing! It may be a mind thing with us, but for now, the tubeless is working. At a karate tourney last year, a mom saw his pump and started yelling about cheating! That was enough for him to want to hide it all. No the new deal does not include the 10 pods. You have to have insurance approval and then you pay for the PDM. After your 3rd order you get $50 back. Henry Ford only does 3 month shipments so we just had to give the reciept for that and we got our CC credited the money. The insurance just swaps out pods for infusions sets and we drop the cartridges from the order. It really was a painless process.
     
  3. Judy&Alli

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    No they do not pay for Dexcom. We pay oop.
     
  4. Melissata

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    I understand the IOB because it is also an issue for us. Melissa still will give herself a correction when she shouldn't, she just did it the other day and went low. She doesn't understand time well, so it was right after breakfast and she gave herself a correction. I don't really want to set a higher target though because then she won't get a full correction when she does need it. I'm trying to carefully let her learn from her own mistakes. I don't know which one of us likes tubeless more, her or me. After years of looking at tubing and figuring out where to put the pump, it is nice. I will be glad if and when the smaller pods get here though!
     
  5. sammysmom

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    I feel the same way! It is nice to see Sammy without the tubes, he has had tubes since he was an itty bitty baby! The higher targets and correct over number works for us because we follow the school schedule. It protects him if a snack happens between brk and lunch. Also he has recess first so it is an extra protection. Right when he gets home it changes back to normal. His last a1c was lower 6's so it seems to be working. I am just mindful of it on the weekends. Smaller pods would be great!
     
  6. ROVERT81402

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    I have Ohio Medicaid which pays for all prescriptions, but I also have Paramount Advantage, through Ohio Medicaid, and they are the ones that pay for all of his pump supplies. I was told that he could get a new pump in April, which will be 5 years since he first got it. I'm gonna have to call around Monday to make sure!
     
  7. Judy&Alli

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    Heather, as soon as you hear something could you please let me know? I am very interested. I am starting to think they don't know what they are talking about. Thanks so much!!
     
  8. jcanolson

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    Could it be 8 years or when the pump breaks? Our insurance told us 6 years OR until the pump breaks once out of warranty. The rubber around the buttons was peeling away and there was a hairline crack, so we did get our at the 4 year mark. Eight years seems excessive. Have you talked with MM. The pump companies seem to know these things better than the average person in the Medicaid offices. Good luck!
     
  9. ROVERT81402

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    I definitely will let you know what I find out :)
     
  10. ROVERT81402

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    Ok, so i called the ins company today and they told me that the endo will have to get a hold of their utilization dept. and go over the criterias with them. As long as Trevor meets the criterias then he can get a new pump. So I guess you'll just have to have your endo do the same.
     

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