We are comparing insurance plans for our enrollment.
Is there anyone here who uses OmniPods and who has Anthem BlueCross/BlueShield insurance?!?
Wondering if BCBS is easy to work with and get approval. Don’t want to have to fight for it again, like I did with United Healthcare.
Really the only thing I need for insurance is NovoLog and pods. I can probably swing everything else for a year with no insurance if I needed to.
Any thoughts on BCBS and pods?
Thanks.
My opinion is simply that UnitedHealthcare is the absolute worst option. I’ve been enrolled in a UHC vision plan, UHC health plan, and a plan that contracted mental health benefit coverage to UHC (I see a therapist every few weeks). I’ve had claims rejected in all of these plans. I’ve never had a claim rejected under any other insurance carrier’s plan. That isn’t to say that it can’t happen, but rejecting seems to be a knee-jerk reaction with UHC. I honestly think that they just try to weed out those people who will just pay because they don’t know how to appeal the claim. I’ve interacted with the company professionally as well, and I think they’re slimy.
I’ve never been on a BCBS plan though, so I don’t have much to say about them. Aside from UHC (which I’d reject outright), I’d probably just call the company and ask about the benefits I wanted covered and their procedures for appealing rejected claims. I imagine you’ve done that before though, so that’s probably not a particularly helpful comment.
I’m currently in love with Cigna. I genuinely have never been so pleased with an insurance plan as I am with my current one. I’ve been on two of their plans, and it’s generally pretty easy. I had to do a little bit of work to move things forward on getting my cgm ordered/approved, but I fully blame Dexcom for that.
No experience with a pod. Wish I could help more.
@Eric. Been on BCBS for a couple of years and never had a problem with Dexcom or insulin, or anything else pharmaceutical. Both years I reached OOP early in the year because of illness, but have always been amazed to get Dexcom and drugs at no copay.
I never tested them with Omni Pod, but can’t imagine their being any different. The only complaint I have is they don’t cover Contour Next strips.
I have BCBS, but it’s not Anthem here… not sure if that makes a difference? I didn’t meet their criteria for OmniPod, but the rep didn’t seem to have much trouble getting me approved anyway.
Humalog is preferred on my plan, but that’s what I use, so I couldn’t tell ya how easy it would be to get novolog.
Knock on wood, I’ve had zero real issues with them. The Omnipod approval letter I got said they were approving through June 2019. My fingers are crossed that it’s not a fight to get them re-approved.
@kpanda01 I think insulin is more dependent on the pharmacy benefits provider on your plan. I have Costco and they never gave me a problem with Novolog.
For that matter, a lot depends on what the insurance contract between your employer and insurance company have.
I haven’t had any problems, knock on wood.
@Eric I’ve had Anthem BCBS for years (prior to my T1 diagnosis) and had no issues getting approval for my Omnipod or Dexcom. I’m very happy with Anthem BCBS. I think a big part of it is due to the employer plan we have. Honestly, I’ve rarely had a need to contact them.
Based on your post, I was reading a bit on Anthem. I had heard of them but didn’t realize how big they were.
I Think?? this is the formulary for Anthem BCBS? I see it lists Humalog but does not list Novolog.
(Medicare specific formulary - Maybe the same? Maybe not?)
You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a predetermined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level.
It sounds like you would have to do the same thing as you did with UHC at least for the Novolog?
EDIT: Non-medicare Anthem BCBS formulary (below link). But older. Effective Nov 15, 2016. Still lists Humalog and not Novolog. Interesting, this also lists Afrezza.
https://fm.formularynavigator.com/MemberPages/pdf/Preferred4TierformularyFDB_7449_Full_2083.pdf
Following (below link) is somewhat interesting.
A lot of blah blah blah…
But there are various interesting pieces in there.
Use of a disposable external insulin pump with no wireless communication capability (for example, V-Go®) is considered not medically necessary under all circumstances.
One might assume that the writer of the article was very clearly ensuring that the Omnipod did not fall into that sentence? Otherwise, it could have been written less specific?
Also interesting about replacing pumps. Apparently not automatic when the 4-year warranty expires.
The replacement of external insulin pumps is considered medically necessary when the following criteria have been met:
- The device is out of warranty, and
- The device is malfunctioning, and
- The device cannot be refurbished.
https://www11.anthem.com/ca/medicalpolicies/guidelines/gl_pw_d073854.htm
Thanks for the links, Thomas. I read through them and they are definitely not easy to decipher! 
I looked at my options of which company to go with, and I think the Cigna ones seems like it would be easier for me to deal with (but more expensive). The BCBS plan was much cheaper, but I don’t feel like messing with all of the appeals. I’ve done that before, so I want to take some time off from my hobby of doing appeals.
Yes, and yes. We use and have used BCBS for over a decade and love it. And we have Omnipod. No issues ever with them. We use Novolog and Pods and they have never given us issues.