I haven’t been on this site since my diagnosis at least 5-6 years ago, it’s nice to see some of the faces I used to communicate with are still on here and the forum is still up and running! I learned so many things here.
I had to change my marketplace insurance this year, due to Aetna backing out. Unfortunately, my HBCBS insurance isn’t as comparable as they marketed it, and for the first time in 5 years I will have to come off of my Omnipod pump and go back onto pens. I’m just reaching out on here to ask what others experiences were with this, whether it be pump breaks or a similar situation that forced them off. Just so I know what to look forward to. I believe I have one pod left aside from the one I’m currently wearing, any info shared is appreciated.
What POD do you use and would you accept an immediate supply (If you use the Dash PODs), if I were willing to ship you some, to hold you over for a couple months until you sort through the info?
I believe MDI is not medically equivalent to pump therapy, therefore I suspect you may have some choice. The problem is finding out what it is… Omnipods were, originally, “DME” - durable medical equipment - but because of MediCare that didn’t work and Insulet switched to a prescription-primarily model. As a result my ACA insurance switched to letting me get the 'pod from Walmart; I waved goodbye to EdgePark and breeved and enormous sigh of relief.
Check the formulary of your new provider. It is best to do this with the telephone, the POTS; their web may lie. Possibilities for prescription pumps seem, ATM, to be the 'pods and twiist so you may be able to swap to twiist.
Check your endo; endos should know what to do. GPs certainly not.
Insulin pump therapy is an accepted, important and in many cases essential part of treatment for diabetes. If your insurance company doesn’t think you need it they can put you on “step therapy” (the medical equivalent of a performance improvement plan) until you prove that you do (easy.) However I don’t think they will; that would be utterly dumb on their part. They just want you to give up but if you don’t they’ll fold given an informed and capable endo in your hand. Medical poker.
the first answer is to go to your provider and ask them to write an appeal based on necessity. Continue to appeal as long as possible, plan on 2 or so denials at least before you make some headway. Appeal, Appeal Appeal.