Tonight I'm scared, depressed, angry and confused.  I started with the OmniPod System in August of 2009.  I never would have done it if I thought for one moment my insurance would only pay 50% of the cost.  I talked to my insurance company before I ordered it to make sure they covered the equipment 100% and they assured me of this.  I just received a letter from them that they'll only cover 50% since April 2010... it's now August 2010 and I owe over $1,000 to Insulet.  I can't even imagine going back to giving myself shots 4-6 times a day like I used to and the uncertainty that I'm figuring everything out correctly.  I'm going to call them in the morning and I pray this is a mistake.  If it isn't, I have no choice but to give it up.  Has this happened to anyone, if so, what was the result?  My insurance Co. is Horizon Blue Cross/Blue Shield and the ironic part is the premiums were just raised $30. a week. We're paying a fortune for this insurance.

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Hi Janet...yes I had a similiar situation with my insurance Anthem Blue Access,I was approved for the pod in July 2009 and then in March 2010,I got a letter stating that the pod was not medically neccessary /experimental...yada yada yada......I had to appeal the decision 3 times finally I got my employer involved .I work for a school district and to make a long story short ,The Treasurer of our district called Anthem and got it pushed thru for me...Please don't give up! ask your employer to get involved....Best Wishes to you!
Janet - I had a similar situation, I got my physician & Diabetes Educator involved in the letter-writing, phone-calling campaign. One of the end-results from BC/BS for me is I have to call quarterly to have a 'pre-approval' type code assigned to any orders from Insulet for the next 3 months, then the orders are covered at 100%. The order I received with the outstanding balance Insulet let me set up a payment plan to pay off. The employees I spoke with at Insulet were very understanding - ultimately, they want to keep us as customers! Let us know what happens, and don't lose hope.
Janet - I agree with Patti and Traci, get others involved! Dont let them (the insurance companies) dictate what is good for you and what isnt! DONT TAKE THIS LYING DOWN! (IN case you havent noticed I have a bit of a chip on my shoulder re: INsurance companies....read my tales at http://www.supportersofsurvivors.com) I have become a bit of a "squeaking wheel" with my Insurance Company, we have gone through so much (my wife and I ) we have run the gamut on just about ANY insurance nightmare! If oyou need to get lawyers involved....let me ask....did you get the initial approval in writing?
My insurance company story isn't so positive. I started with the Pods in February 2009 but this July when out insurance packages came out they switched coverage of all durable medical from 100% to 70%. There's nothing I can do about it because it doesn't matter if it's the Omnipod, Animas, or any other pump, none of them are covered in full now. There is a cap at my spending at $1500 but it's scary to think that I suddenly have an extra yearly expense of $1500. You need to talk to your insurance and figure out why it's only covered at 50% to see if there's anything you can do about it.
Thank you all. I talked to my insurance company this morning and the rep said she couldn't figure out why they told me it was covered 100% last August and they paid 100% until April of 2010. It was all verbal, I never got anything in writing from my insurance company. Big mistake on MY part, live and learn. I called my lawyer a little while ago, explained everything to his secretary and he'll get back to me. I really have to keep myself from getting too upset because I have more than a full day's work ahead of me today and tonight. Whatever the outcome I think I'll just let my lawyer handle it.
Cool, Janet! BE strong! YOu'll get through this day...and it will make you even strongrer!
I feel quite empowered tonight. I called Insulet and she told me they never received ONE payment from my insurance company. But she told me not to worry about it because they have all the documentation and written agreement from my ins. co. that they'll pay 100% of all charges. She told me that Insulet will deal with them, not to worry because I don't owe them anything. THERE IS A GOD!!!! Meanwhile I will keep my lawyer posted on all that's happening. Thanks everyone for your support.
Rock on!!!!! GO INSULET!!! It is nice to read something NICE about INsulet every now and agan!
Great news Janet! Best of luck in resolving this issue.
Hi Janet- I just changed jobs and will have BCBS NJ within a few days...can I ask what kind of plan you have (HMO/PPO etc)? I'm so nervous now!
Hi Carly... I'm so sorry my post got you nervous!! Nervous is not good for us. I have HMO and the company is Blue Cross/Blue Shield. If I were you I would call Insulet AND your new insurance company to find out exactly what you're covered for. I'm sure it will be ok. Insulet told me that my insurance company is making a mistake thinking this is "Out of Network" in which case I would owe 50% but that will all be straightened out. I'm sure it will be ok for you.
Enjoy the holiday.
I'm just outside of Philly and have Keystone East Insurance which is a form of BCBS. For me Insulet is Out of Network but Insulet set me up with CCS Medical (a Medical Device Supplier) which is in Network so everything worked out fine. My insurance has still changed so that I now owe 30% (which is like $10 / month for all my test strips and lancets and then another $10 ever 3 months for the pods and skinprep wipes). Unfortunately, the negotiated price for my Dexcom sensors has me paying like $91 / month which is killing me. You'll have to check with your insurance personally as BCBS is kinda like a franchise with different policies and prices everywhere but overall they seem to be one of the better options!

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