I’m on the Omnipod original pods and they claim they DO NOT cover them at all and gave me the info for medical necessity.
Does anyone have the clinical NDC# or whatever it is called for the original non dash pods? Any good wording/verbiage my doc can use to prove it is medically necessary?
Any help would be greatly appreciated.
Eric provided a comprehensive list of codes in this thread.
https://forum.fudiabetes.org/t/list-of-ndc-numbers-for-diabetes-equipment-and-meds
@Erics’s update was for the Omnipod UST400 10 pack (the UST400 is the pod prior to the Dash, there was at least one version before that). The issue here is that Omnipod have changed to a 5 pack, apparently as part of moving to a pharmacy benefit. CVS certainly stock those, but if they are giving you the medical necessity stuff that means your insurance company does not cover them. I suspect pharmacies can only supply the 5 pack and medical equipment supplies the 10 pack.
The single best way to get the correct NDC codes of the moment is to telephone Insulet directly and explain the situation. They were perfectly happy to give them to me (and I promptly forgot them after passing them on). They can also help with insurance but the medical necessity thing is invariant; if they are asking for it it means your insurance company is denying the claim.
In my case I was getting the UST400 through EdgePark (as DME - Durable Medical Equipment), my insurance company apparently switched to handling Omnipod as a pharmacy benefit and things went squirelly with EdgePark. Of course no one told me what was going on.
The reverse applies too; if your insurer is covering Omnipod as DME they will deny a pharmacy claim. That may be what is happening.
Take a sick day or two, draw up a telephone, and start with the insurance company.