I have been waiting for the OmniPod to arrive in Canada for over 2 years now. I was a former user of the OmniPod when I lived the US and I want to go back on it as soon as possible. Now that it is finally available, I had my doctor fill out the medical necessity form and my drug plan responded with a letter denying me coverage. I have group coverage through the Nova Scotia Teacher's Union which is through Mediavie Blue Cross. The said the product is new and isn't approved yet.

Has anyone else had any luck getting the OmniPod approved by their drug company? I just wrote a letter to ask special permission to have it approved just for me, but I won't know if it will work or not. If anyone else has it approved, I would love to know who with so I can use it as an example to them.

Tags: blue, cross, omnipod

Views: 648

Replies to This Discussion

Hi Coombs. I was just denied by my insurance company for Omnipod also. They said they do not cover anything through Omnipod. I am assuming that this is because it is still new and that Omnipod is still working with the insurance companies to get things moving. I know that they are also working to get coverage through ADP here in Ontario. I am not sure if you have an ADP program where you are but many of the insurance companies may be waiting to see if the government decides to cover. If the gov't covers then maybe the insurance companies will follow. This is purely speculative on my part however.

Good luck!!!

Rob
This is timely since I was just looking into getting extended health insurance for this very reason. Blue cross seems like my best option here in BC, but I haven't spoken to anyone there yet to see what they will cover.

Is it just the Omnipod or all pumps that they won't cover? I was told that the omnipod is the cheapest one currently so you'd think they would like that. If it's all pumps you may be able to get your doctor to write a letter saying it's medically necessary.
My Pump Nurse has arranged in my Community to make available the 3 pump Representatives speak on their latest pumps : Animas, Medtronic and Omnipod to interested individuals November 5 , 2011 . An opportunity to ask the question from the Omnipod Rep about Insurance coverage, I plan not to miss ...at least here in BC .I''ll report back here .

Extended Health Plan coverage through Employers maybe different for the insurer ...in my case Pacific Blue Cross covers a pump for 5 years and will only replace, if the present pump is not functioning after the warrenty has expired ...my CareLink
( Medtronic ) upload program had stopped working ...and the 522 was out of warrenty .
I attended the Canadian Diabetes Association's NAGM in Toronto and was able to visit the OmniPod booth at the Conference .One may already be aware , but hope this is helpful ..... their brochure states , quote : " After deciding pump therapy is right for you , give us a call at 1-855-POD-INFO ( 1-855-763-4636). Our OmniPod Customer Care team will work with you , your healthcare provider and insurance company to make the ordering process easy for you " .The package contains forms as well , which one can fax to OmniPod Customer Care .

I understand, that ADP in Ontario covers OmniPod ...check with your Rep or contact very knowledgable
annette.p.payne-wilson@gsk.com , who covers BC ( and maybe beyond ???) ...she will lead you to whom you should connect with , no doubt .

After writing a letter to my health plan administrator (Johnsons Inc.) explaining why I need to be on the OmniPod, I received special approval to purchase the pump. Blue Cross is covering 80% of the costs. I received the pump 2 weeks ago and had an appointment with the pump nurse today and got set up. I am noe back on the OmniPod!!! Feels nice after waiting two years.

Great news , coombs ...the month of November ( diabetes month ) has been good to you ??

Our drug company (Sunlife) did not approve the Omnipod, however, the Province of Ontario began covering it Jan 1, 2012. I am not too sure if they would cover any pump at all since Provincial funding is available for them if your Dr. says you need it. I am in process of getting started on it as we speak, albeit, early on - I have gone through the Endo stuff, nurse, dietician discussions and now await the final paperwork to submit (shortly). I am told it won't be too much longer now..

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