Hello! So I’m completely frustrated with my insurance through my employer. They have eliminated coverage of my freestyle strips which I want to stick with because of my omnipod. It’s just convienent having it all in one device versus having to have multiple devices with me at all times. Well, my formulary will no longer cover it even with prior authorization (and won’t let me get coverage over the most recent omnipod which isn’t even new) so I’m looking at insurance through the state exchange to see my options. Does anyone have any advice on which companies they’ve had good experience with or any that they’d try to stay away from?
Are there any other employer plans you can switch to during open enrollment? A new one might grandfather in items you’re already using if they’re not part of their formulary, even if they would not cover them for new users.
I suggest you check with an insurance broker to get details about plans for the coming year - they may change a bit from what someone has now.
Hi again. I had another thought, and please forgive me if I’m rehashing in this reply or my previous one, things you’ve already looked into; but - as I some pump supplies are now covered under pharmacy benefits rather than those for durable medical equipment, and I’m wondering if that may be the case with your Omnipod.
I’ve tried working things out on my own with insurance coverage re my pump and CGM coverage, and only ended up with an enormous headache. I turned to my device rep for help (one time I actually conferenced them in with my supplier and insurance) and they got things worked out and squared away in short order. As I listened in on the conversation I really felt like they were speaking a different language; and it felt like they were coordinating requirements I didn’t even know existed when it came to required documentation.
Anyway, if you haven’t already done so share your situation and any correspondence with your Omnipod rep review and ask them to intercede: they might get a different outcome, and even if not you’ll have covered all your bases.
Here’s some info re Omnipod Dash and pharmacy benefits. Even if you don’t use the Dash it might still apply and your rep can help you figure it out.
Thank you so much for your advice! I hadn’t thought about reaching out to my pump supplier so I will certainly do that!
In regards to other insurance plans unfortunately all the options I have a very limited. I’m on the best plan I can be on but for some reason they kicked freestyle off even with prior authorization which is all I needed before.
I will be calling my omnipod rep Monday though for the dash coverage. Great idea!
Happy Monday! I’m excited for you and hope your rep is able to determine if your insurance will cover the Dash in lieu of your current system, and even if you can keep your current one is that’s your preference.
You shared that you submitted a pre-auth in hopes of keeping your Omnipod: I’m not an insurance expert by any means, but another thing you could ask your rep about is medical necessity for using Omnipod specifically. As you know Tandem and Minimed have pumps, and while Omnipod is the only tubeless one (at least here in the US) if your insurance covers those it would be worth looking into. However, some people have issues with the adhesive or the actual cannula on those. It would be a stretch to suggest you try those to eliminate any issues but if by any chance you already have and know they simply don’t work, you could try making a case for necessity of the Omnipod as the only one you can use. I believe Tandem lets you try their pump for 30 days before you make a 4 year commitment - I don’t know about Minimed.
That’s a crazy, last ditch effort and hopefully your rep can help you find a better solution but I thought I would toss that in the wind for you to discuss with them.
Looking forward to hearing what happens - it make take a few days to coordinate everything - all the best while you wait!
I’ve have both bluecross blueshield and had health alliance in illinois. I hated both. Have trouble getting covered for anything. They both really want you to use their “preferred” brands and products.
I’ve had problems for years getting what I was using/needed through my employer health plan. You have to fight them, but it’s worth it. Even if they’re saying something isn’t covered with a prior authorization, they MUST cover what your endocrinologist says is ‘ medically necessary’. Now getting your endo to write that letter may not be easy, I had to push mine to do so (they’re so busy), but once he did they immediately started covering. This happened with both the insulin and the Freestyle Libre CGM I was using. Every time they change the formulary to exclude what I’m using this is necessary.
Reach back if you have any other questions, I’ve been through it and am happy to help. Good luck !
Yeah, you have to keep fighting. I finally got dexcom approved. I was paying out of pocket for free style libre.
Thanks! I had no idea you could do this so I’ll give it a shot. Thanks so much!
Ugh! The stuff we have to go through to get what we want/need for our management. I’ll keep going. Thanks!