I had a great run with Omnipod ordered directly from Insulet Corp. Insulet handled everything when I got started, orders showed up on time and hassle free and my co-pay was not too painful in the grand scheme of things. Now my insurer decides to switch everything up. Received a letter stating that “Insulet Corp is not currently in-network beginning on June 1, 2021”. Naturally the letter showed up about a week prior to June 1. I dread dealing with DME suppliers just to get boxes of pods…my guess at this point is my co-pay will double or triple and ordering will be a huge hassle.
I’ve tried with this insurer get pods covered under pharmacy benefit but have had no success. Their latest response was “Since Omni Pods are inserted into a medical device and administered through the medical device they fall under the medical device benefit.” LOL, it took them a few years to learn what a CGM is, now they need to go back to school about pods.
The question is: has anybody successfully cajoled their insurer to cover pods as pharmacy benefit rather than DME? My insurer says I should submit a grievance. Has anybody had success with this health insurer grievance process? My inclination is to call the pharmacy benefits dept. and educate them first before the grievance.