Omnipod Users

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Comment by Abyssinian1 1 day ago

I'm not getting my insurance through my employer any longer. They dropped the EPO option that covered my Omnipod, pods and testing strips at 100% and replaced it with an extremely high deductable plan with an HSA instead. I would have had to hand over the first four months of paychecks into the HSA to meet the deductable as well, so it was as if I'd totally lost my insurance.

Given that, going with my husband's insurance seemed smarter, at least at the time. Now I find that none of the stockpiled equipment, strips and such will work with the Kaiser plan and they don't want to even let me go back to the Lantus option. Funny, how all of the brand name insulins seem to be off-limits to me now. I guess the only insulins I'll get are Regular and NPH. Where did they dig up these policies? Oh, wait, they must have perfected a time machine and brought back docs from 1980 because that is what I'm seeing as far as insulin and treatment recommendations.

I want to ask them "Hey, Kaiser docs...Why don't I just go back to using the chemistry set with the eyedropper and the tablets to test my urine as well? Or the glass syringes you have to boil to sterilize? That ought to save you a bundle on blood testing equipment, disposable needles and Omnipod refill boxes!!"

I think the difference between our two situations, Mat, is that there is someone within the Anthem network willing to see reason and who had the authority to get you the pump you needed. The Kaiser system is different and I'm beginning to think everyone within that system has been drinking the Koolaid about how great the Kaiser model is. What I need is the Kaiser equivalent of the woman you had at Anthem. I know that there are people who have had run-ins with Kaiser about acquiring a pump and what a headache that's been. I have to figure out how to reach whatever shadowy group within Kaiser it is that can grant exceptions to rules that seem to be chiseled in concrete.

Comment by Mat on February 7, 2010 at 12:46pm

So I had a similar experience with Anthem of Colorado, I thought I was going to have to switch or pay for it myself but after about a month of making calls and trying to figure it out, I got in touch with a woman at Anthem who fixed everything for me, I had completely resigned myself to the fact that I was screwed and she just took care of it. So don't give up! Does your employer have any other insurance options? If you could switch to Anthem, which I'm guessing is unlikely, I know how to navigate their system now so I could help with that.

Bottom line is it's your life and it's your health, try not to let the frustration you feel with the insurance in industry stop you from taking good care of yourself. I know it's easy for me to say that, and it's really hard to do sometimes. I hope you can get the omnipod covered and I'm sorry you have to go through this.

Comment by Abyssinian1 on February 7, 2010 at 12:12pm

Natasha - Exactly. So what I may have to do is get the software from Intuit (the BDC had it so I didn't have to go to the trouble of outputting my own records), run my own records the day before, take them to Kaiser and hand them to the endo there. Sadly, I don't even think they'd know how to interpret them, as there is no relationship between Insulet and Kaiser.

So yet again, I have to do everything for myself. Thank you Kaiser. You've just reaffirmed my belief that no one cares about a Type 1 diabetic or their needs once they get past the age of 18.

The other thing is the Freestyle test strips. The Omnipod uses those exclusively (my one beef with the proprietary nature of the relationship between Omnipod and the strip manufacturer), and of course, Kaiser doesn't deal with Freestyle either. They only allow One Touch meters. So all of the strips I have would become useless as well. To me, forcing me off of a paid-for pump and making all of my supplies useless in favor of making me either go back to the needle (and the severe hypos) and puchasing a whole bunch of new strips at a higher cost from a different manufacturer than what I paid for the ones I have now would financially hurt me at a time I don't need any extra expenses.

Does anyone on TuDiabetes have any experience with navigating Kaiser's Byzantine system?

Comment by Natasha Bowlds on February 7, 2010 at 11:39am

Wait - they don't have the equipment to read it? The "equipment" consists of a USB cable, which I bet they could find one of, and software - which for a consumer of the Omnipod is FREE. I'm sure they would give it to Kaiser for free too if it meant more customers for Omnipod. That sounds completely bogus to me.

Comment by Abyssinian1 on February 7, 2010 at 11:22am

Thanks, Sue. I appreciate the kind thoughts and the prayers. I may need them. I will try to be diplomatic with the endo. If I end up with someone who treats me like a Type 2 diabetic and has no clue about how to deal with a Type 1... well, gloves will be off.

The thing is, I have no illusions about the profit motive behind Kaiser's operations. It will always boil down to making money (for themselves), saving money (for themsleves, not me) and getting out of paying for anything extra. A good example are the shoes they want me to wear - they say I have charcot foot. The problem is, I've had my feet examined for years by physicians at the Barbera Davis Center's Young Adult Clinic, who should be experts in this sort of thing. Never in the seven years that I was seen there did they come back with this kind of diagnosis. Now the GP at Kaiser wants me to spend what will amount to a lot of money for shoes that I really don't feel I need, from one of the companies affiliated with them. Why do I have to suddenly buy very expensive diabetic shoes, and yet go off of all of my brand name medications and insulins in favor of ones that I KNOW don't work as well and give up a pump that I need in favor of a model I consider inferior? It makes no sense, other than for the reasons above, none of which include what's best for an individual patient.

The only reason they won't let me keep the Omnipod (Insulet replaces any defective pods for free - do any of the manufacturers of tubing and insertion sets do that? No? Well then!) is because they don't have a business relationship with Insulet. The practitioner told me that they only have two manufacturers they deal with and I'd have to give up the Omnipod because they don't have the equipment to read it. The factor here is convenience for them, not me. Kaiser also serves as a customer funnel for those two companies, in exchange for what they consider 'favorable rates'. It isn't about the best pump for my needs, it is about how much money they can give to their business partners. And I REFUSE to play that game. I"m not one of their 'good little diabetics' who blindly follows orders and doesn't question the why of what they're doing.

Congratulations on surviving 30 years with this nasty condition. I chalk up living this long to trying to take care of myself and being willing to fight for myself and what I need. Considering everything working against us, Type 1's have to be willing to fight for our own well-being, since no one else seems to be willing to fight for us.

Comment by Sue on February 6, 2010 at 8:34pm

Good evening. I hate to hear you are having such a time with this and it sounds really stinke.

I know you are ready for a battle but before you blow all this on the endo, see what they say first. A lot of endo's will go up to bat for you. Pause a moment and think, a general practioner is just that, general. They aren't specialized like the endo is, so take a deep breath and go into the meeting with an open mind you might be surprised. I pray so.

It is nice to hear from someone that has been fighting diabetes for 30 years like I have. I agree with you tubing stinks. Good luck and I hope to hear of a good report from the endo.

Comment by Abyssinian1 on February 6, 2010 at 10:26am

Hi. I'm in a situation where I've traded a very good insurance plan for Kaiser Permanente and so far they seem more worried about patient privacy and taking away my current medicine regime than continuing treatment. I have my first meeting with the Kaiser endo on the 15th and so far, the general pracitioner I was given said that I a) can't have Lantus as a backup any longer, b) will have to give up the Omnipod because they don't have a business arrangement with that company, c) same for all of the Freestyle strips I have, I guess they only allow the One-Touch, for the same reasons and d) will have to go off the the Advair I've been successfully using for years as an asthma treatment in favor of a much less effective medication (I've had to use my rescue inhaler more often in the last two weeks than I have in the last three years). I'm actually looking forward to going in because the initial visit ticked me off so much that I'm literally spoiling for a nasty, knock-down drag-out fight with the endo and will do whatever it takes including standing naked outside of the building to get the treatment I want and need and AM PAYING FOR. My Omnipod won't cost them a dime - I already have it. Why should I give up something that keeps me from having severe hypos? I'd even ask the Omnipod manufactuer for the software to download my results for the last three months. Anyone else have these issues with Kaiser - are they all such smug know-it-alls who think that they know more about this illness than someone who has lived with it for 30 years? I've seen more stupid rules and regulations with Kaiser than I have with any private physician and I'm not giving up my pump. I chose it because I hate the idea of tubing and because it is convenient, and patient convenience and ease of use seems to be the last thing Kaiser cares about.

Does anyone else have any idea how to deal with these thugs?

Comment by Sue on February 2, 2010 at 9:51am

I know this is last minute but for the people in the Charlotte metro area the omni pod rep is having a support group meeting tonight. Omnipod info session Tuesday night (2-2-10) from 6:30- maybe 8:30. It will be at the Hampton inn suites at I-77 and arrowwood. If you are able to attend please contact Joel at jworthy@insulet.com. Have a good day.

Comment by Bernard on February 2, 2010 at 5:18am

I posted an interview with Kris Freeman, the Olympic cross-country skier to my diabetes technology blog. Kris is an Omnipod user and for an interesting reason.

Comment by Todd Carey on January 30, 2010 at 11:11am

Bradford, my thought exactly....I was thinking that if anyone here ever wanted to become a senator or something, they could be in trouble with some of these phrases.

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