So UHC has learned a new trick. They no longer have to fight appeals.
Under my policy, they say it is covered, but at 0%. Then when you reach a certain level of deductible, they pay a percentage.
So you can’t appeal it and ask for coverage. They say, “But it IS covered, and the plan says it is covered at 0%…”
Since it is covered under DME and not pharmaceutical, it is much harder to reach that deductible amount.
Wow, if they only cover 0%, that is NOT coverage. They are being very misleading.
I had an expensive surgery last year so I met my deductible early on and that meant I paid 0 for my supplies after the surgery. Unfortunately, going through surgery is not the best way to get diabetes supplies at 0 cost!
It’s funny how quickly I can hit my deductible on pharmacy stuff! I can get there in about 1-2 months!
But medical usually takes much longer.
It makes no sense that UHC considers OmniPods to be DME (durable medical equipment).
Come on, UHC jack-
's! They only last 3 days! How do you consider that “durable”?!?
The 0% thing sounds like a lawyer found an interpretation they could wiggle thru! 0% seems more like an admission of no coverage (no difference between “not covered” and 0% in its effect/impact). A legal challenge that will would likely take years could resolve it, though it’s a toss up whether a temporary injunction against UHC/others would stop them from reaping the benefits of the interpretation. Hopefully, other insurance CO’s don’t take UHC’s lead…
On the other hand, watch what you ask for regarding DME or pharmacy. Depending on people’s insurance coverage it could be a good thing or a bad thing. That said, I’ve never understood the Medicare “illogic” of pump coverage and insulin coverage…makes no sense to me.
The DME is the controller. The pod is disposable supplies essential for the DME to be useful, so they can be covered under the DME benefit. That’s the same approach as Dexcom used for their CGMs. The controller was the DME, and the transmitters and sensors were the essential disposable supplies. Years later Dexcom was able to negotiate pharmacy benefit coverage with some plans, but that didn’t come first.
Which is ironic in itself, since I have not once used the controller with my Dash pods! It’s still in the box. I have never even taken it out.
I have only used my iPhone.
Same here on Medicare pharmacy coverage. There is a new OOP annual max of $2,000. I will be hitting that in June, thanks to regular supplies of pods counting against it together with a $500 deductible counting against it, plus insulin. After that I think my copay for pods and insulin will be zero for the rest of the year. Seems crazy…