Insurance will not cover Omnipod

Hi, all! After consulting with my endo, I decided to get a Dexcom CGM. Unfortunately, my insurance provider only covers Medtronics pumps, which are only compatible with Medtronics CGMs.

Now that I am considering the transition from multiple injections to a pump, I am very interested in getting an Omnipod because I believe it will fit well with my lifestyle. Since my insurance company will not cover it, I was curious to know: Has anyone here paid out of pocket for the Omnipod or applied for financial assistance through Omnipod? Could you please give me a rundown of your experience (costs, ease of acquiring, etc)?

Feel free to message me privately if you are uncomfortable putting your financial advice/history on the forum.

Thanks!

Hi @Dev_Renae Devin, have you worked with Insulet regarding your insurance? Are you positive your carrier will not cover Omnipod? Have you threatened your insurance? Some companies “give” after enough appeals.

Even though DEX will not integrate directly with Medtronic, there is no reason you can’t use them together. The blood sugar may not appear on the pump screen but who cares really, unless you were looking for basal IQ (from Tandem) I am pretty sure omnipod doesn’t integrate with DEX at this moment either. Cheers good luck.

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@joe, I have not worked with Insulet nor have I ever filed an appeal. Up until March, when I was diagnosed, I had never used my insurance for more than the annual check up. All of this is brand new to me.

I appreciate your input and I will definitely research a bit more. Thanks!

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Contact the manufacturer, explain that you are interested in the Omnipod and your insurance won’t cover it. They will have experts that can help you and your endocrinologist file the appeal. They have a huge financial incentive to get you insurance coverage on their device. The endocrinologist can say that it is medically necessary for you to have the omnipod over other pumps. With you being a flight attendant, I would guess that is very necessary.

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Thanks, @SpecialEDy! I was looking into the exception vs appeals claims today! I will definitely be doing this.

@SpecialEDy ALL PUMPS are safe for air travel. All of them. None, by type or brand, have exclusions listed in their respective documentation, for aircraft/travel. Please try to refrain from posting inaccurate information.

They have limits on atmospheric pressure and relative elevation. Pressure limits that are close to normal for air liners, pressure limits that are far below regulation for air liners.


Here’s a study of outgassing in flight, those are some pretty significant discrepancies in basal delivery, I’d essentially be doubling my programmed basal rate. Pretty interesting that a rapid decompression event will hit you with a large bolus too, you’re going to need to eat before that emergency landing or you probably won’t be conscious for it.
It’s a $10,000 piece of equipment holding many lethal doses of insulin. Maybe it doesn’t specifically state that you shouldn’t fly with it, but there’s a lot of things it doesnt say you shouldn’t do with it. At least with the Medtronic, you are pushing the boundaries of safe operation. This is the first time I’ve ever seen anybody advocate its safety onboard a flight.

the United States Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation.

There is no warning label on any pumps regarding air travel. The report you refer to is almost 8 years old, if there was anything relevant in it, there would be warning labels on the products impacted.
It is totally OK to take care of what is best for you, and as such if it is your opinion that it’s unsafe then by all means take care of yourself.

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