UMR/United Healthcare and Tandem Pump?

Type 1 & LADA
1

Hi all, this is my first post here and I’m hoping for help. I tried using the search function and surprisingly wasn’t able to turn up much on this topic.

I just made it through five months without heath insurance, and unfortunately (fortunately? idk nothing feels like good fortune these days) ended up at a new job who offers United Healthcare Choice Plus insurance through UMR. I can’t find anything about coverage on UMR’s site, but have run into an onslaught of confusing information about United Healthcare’s ■■■■■■ insulin pump policy.

I’m hoping to get a tandem pump as I’ve already fulfilled an order for dexcom g6 (through Byram…an annoying waste of time albeit slightly less of an annoying waste of time than dealing with dexcom’s incompetent service directly - why does none of this work how it should? it’s 2020 let me live).

My questions:

  1. Do you know if United will cover the tandem pump as out of network? I’m covered at 95% for in-network and 75% for out of network, so if so it wouldn’t be too much of a problem. 75% for out of network is better coverage than my last joke of insurance provided for anything.

  2. Do you know if tandem provides any incentives for someone without coverage?

  3. Do you know if there’s a way my doctor or employer could step in to help my case with this?

Thanks for any help!

Sincerely,

A type 1 diabetic who is completely ■■■■■■■ sick of dealing with the U.S. healthcare system

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Laughing at the curse words on a forum titled ‘FU diabetes’ being blocked out.

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In or out of network may not be the same as covered vs not covered under the plan.

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Thanks! So - are all pumps other than medtronic not covered whatsoever through United?

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First, Welcome to our corner of the internet! Appreciate you joining.

United Healthcare does have a preference (agreement) for Medtronic pumps, but your physician can always step in and help fight the machine. The reason’s UHC originally gave for the preference have all fallen away as the other companies have caught up, however they still don’t easily allow their members choice.

One of our founding members @Michel successfully fought UHC for coverage of an omnipod. Hopefully he can give you some insight.

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I think to get non-medtronics, you need evidence of why medtronics does not work for you and get reviews, etc. There is another post on this, will try to find it.

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They have an exclusive deal with Medtronic. There have been a few people who have posted they were successful getting a Tandem pump, but the process was long and painful. From what I’ve read, Tandem is not supportive with helping UHC members and will be disinterested in getting involved.

I’m not sure what you mean by incentives. There’s not much they can do if the insurance provider won’t pay for their pump.

Even if you pay cash for the X2, UHC will not cover the Tandem supplies unless you were already using the pump before you signed up with them.

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There’s a long post on the JDRF forum that gives a step by step walkthrough on how to do it. I’d look for it, I’m incredibly lazy today

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Here is a link that describes process.

Is it possible to be exempt from this policy? It is JDRF’s understanding that a small proportion of such requests have been approved for adults and that it can be helpful to have your employer contact UHC on your behalf if you pursue this route. For help with applying for an exempt

Another previous post.

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It’s a long story…

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It stands for “For Unlimited Diabetics”. Of course we were aware of the extra connotation at the time, and we all feel that way from time to time, so it works for us. Limiting the swearing was done on purpose to try and keep it ok for the PG13 families out there.

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