I have united healthcare, and my company just renewed for another year. My t:slim has been out of warranty for a year, I have tried all the tricks to get an new tandem pump approved and nothing worked. Now I see the X2 and I just want it.
Tandem will give you a $700 United Healthcare discount on the cash price. So I will be in it for $4,300 (ouch). I want to wait, be optimistic that UHC will change it policy… So when my dexcom is upgraded to G6, I am going in.
I can’t help but think you haven’t tried all the tricks then. 
That sucks though, and I’m sorry you can’t get the medical device that you want which would work best for you. 
Have you gone up through the highest level of appeals?
I guess if the tandem pump is tubed, maybe they can argue that it is the same as any covered tubed pump?
The bummer to me is that you pay a ton for health Insurance and it doesn’t cover a reasonable request.
Going from one tubed pump to another is difficult to win on appeal. The only other possibility you might not know about is if your company would be willing to do a company-wide exemption to the United Healthcare pump policy.
Contact whoever the plan administrator at your company is, the HR person or whatever. And see if they would be willing to ask UHC for a company-wide exemption. UHC is able to grant exceptions for that.
The other possibility is if you can get it as a pharmacy benefit instead of a medical benefit. @TravelingOn did that, I think. Is that right, Kim?
Eric’s right. Last year, shockingly, the OmniPod was covered under a prescription benefit. JUST the pods though, not the PDM (which operates the pods). But that changed this year. Still covered (because UHC changed their plans to actually include the OmniPod coverage) but not under RX benefits.
Worth trying, for sure.
And I second Eric’s suggestion of asking for a company-wide exemption.
Can you explain this a little bit? How are they covered now, versus last year? Is the unholy marriage of UHC and Medtronic still in play? Or has that changed too?
@mindawhen Last year when I enquired about a cash price for the X2, it was $4995.00 with or without an Installment plan.
If you buy OOP, can you get supplies covered through UHC? Tandem is now using a proprietary connector on the reservoirs.
Sounds about right. Based on the quarterly financial statements from Tandem (yeah - I go after information where ever I can find it) it appears that the company adds approx $3900 as revenue per pump.
Everybody has a different financial situation. I get that. But if the $5k (or whatever pricing one were to get) is divided out over 4 years, that is $100 per month. Depending on your budget that might fit in.
Exactly my bigger question. I would be shocked for UHC to agree to cover the supplies when they refuse to cover the pump.
Insulet and UnitedHealthcare have established a new network relationship, giving individuals enrolled in UnitedHealthcare commercial and Medicaid* plans in-network coverage for the Omnipod® Insulin Management System. Through this new relationship, we are working together to help people access the insulin management technology they need to effectively manage their diabetes.
When does this agreement go into effect?
April 1, 2018
The two most likely possibilities that come to mind:
Always possible I am a bit jaded.
As per post above, I would check on pump supplies. If supplies would not be covered (which I expect they would not) then I would wait.
The Tandem CEO stated (more or less) that Tandem is trying to work the situation out with UHC. However it did not sound like there is anything in the immediate pipeline in regards to this. Additionally, the reason that UHC gave for dropping Tandem from their list was the lack of the Basal-IQ functionality. Clearly, Tandem is in the process of launching that functionality.
So, I think there is a possibility of UHC picking Tandem back up in the 6 to 9 month timeframe. That is just a guess. But if it was me - I would stick with what I had and wait it out. Assuming you can continue to use the t:slim and have UHC cover the supplies for such and get the G6 and use the G6 although not integrated with the pump.
We spent two years on an out of warranty Animas Ping while we were deciding the best route for moving forward.
Our backup plan was MDI if the pump failed. I had the Endo write a [paper] prescription for Lantus. Made sure to keep the script current and replace the script before it expired. We have thousands of syringes on hand. Two 24-hour pharmacies in two different directions in less than an hour’s drive. Perhaps not ideal but enough of a backup plan that I was comfortable running an out of warranty pump.
Thank you everyone. I will try a company wide exemption again, it could not hurt. I also will file with the state insurance commission again, this time with mention of the low-suspend feature.
Than you everyone for your advice!