Ok, I was just put on the Omnipod about 3-4 months ago, and have NO idea why I have never been on a pump! I have been a diabetic for 27 years! That was 27 years of A1C's being mostly high.. So now that I have more control, the unthinkable has happened. I lost my job which means my insurance went with it. Yikes! They didn't even give me a 30 day window. So! Now, I have to figure out what to do in a hurry! I have about 2 boxes of pods left, and I am not quite sure if the PDM is paid for. I cannot afford to go back to regular shots. My new found health depends on it. Any suggestions? I know for certain that medicaid when the state decides to get back to me doesn't cover pumps. As far as the insulin goes, I contacted Lilly. They are working on that issue.
Suggestions appreciated.. Thanks!
Sounds like you are in the US :-(
If you are then you are likely to be covered under COBRA for, I believe, 2 years after an employer insurance policy has been terminated; check it out, even though it tends to be expensive it may well be the cheapest way for you to continue to use Omnipod. Your ex-employer's insurance company should notify you of the option:
Another option that should, now, be available in *any* state is the state high risk pool. Generally you have to be refused by a private insurance company before you can apply, getting refused is easy :-( This is what I did (10+ years ago) and the Oregon high risk pool is still my best (*only*) bet. The high risk pool may be cheaper or more expensive than COBRA; in my case it was a lot cheaper, but then I worked for a company with very good coverage (it had lots of young, therefore cheap, employees!)
If you go to Insulet for Omnipod their list price is $520/box; 52 bucks each. The street price that the insurance companies pay is, however, $250 a box. You could try appealing to Insulet's better nature, but traditionally all medical provides slam people without insurance. Possibly if you offer to pay up front they will give you the street price, but I've tried that with doctors before and just been told to take a running jump (well, ok, the exact words were "go to the emergency room") - they just don't want to treat people with no insurance.
I'm not sure what the going price for fast-acting insulin is; it is a couple of years since I was playing around on the web finding cheap insulin. Last time I did it the prices coming out of the Canadian on-line companies seemed fine (they were actually sourcing in Turkey; the fact that they nominally called themselves CanadaWhatever is irrelevant.) I was buying pens for MDI - make sure you buy 10ml vials, they are a lot cheaper.
If even that price breaks the bank you could consider regular humulin. True the Omnipod is designed for fast acting and Insulet will probably say don't do this but if my choice was between pods+Humulin vs MDI of Humalog(Lispro)+a long acting I'd go for the pod+Humulin first. Humulin is dirt cheap, and it doesn't require a prescription in the US. (In fact most countries don't require a prescription for any insulin.) Humulin was around $20/10ml last time I checked in the US (but that was five or six years ago, and the pharmacist lobby is very active in Congress :-(
You also now have the opportunity to do some price comparisons; Apidra is another choice and there may be others (I don't know.)
John Bowler jbowler @ acm.org
COBRA is very expensive! Mine is almost 800$ a month plus all my 30$ co pays! Some states (NYS) have insurance you can get (like CDPHP) based on your income(you may have to pay a small portion). Good luck! I'm in the process(on my COBRA) of getting an Omnipod.
Thanks! I appreciate the information
Sorry to hear about this. About 25 years ago, I survived with my Type 1 diabetes and no insurance for about 2 years. Prices for the old style insulin and syringes were dirt cheap back then. Going back to MDI might be a good thing for a short time if needed. Good luck to you and a new job search.
Someone just posted a blog entry, talking about Obamacare stuff. You might look into that as an option. It might provide some low cost solutions for you.
When I was getting my omnipod they told me the cash price for a box of 10 pods were $275 and it sounded to me that they bill you and you can keep paying down your bill if you cant pay the whole payment..I would call them and explain the situation :)
That's approximately what they told me in August 2011, although the price was considerably lower ($256.30). They did, however, know I had insurance. The price on my latest bill was $275 (six months later, so that's a 15% API inflation!)
They also originally told me that the pods were billed as "medical supplies", but in fact they got billed as "durable medical equipment", which means that I now have to pay 70% of the cost plus the first $1500.
This means the whole thing is almost impossible to budget; it would help if insurance companies were required to give a quote to customers before offering individual insurance. The companies have the trained medical billing technicians and the computer programs to work out the actual cost, it just takes them a few minutes of data entry to come out with a real per-month cost but it's pretty much impossible for an individual.
Hi jbowler, I would challenge the "durable medical equipment" designation. When I was first considering the cost of going on a pump, I told the OmniPod rep that I needed a good cost estimate before deciding to commit. So OmniPod's people talked to my people (BC-BS insurance) and told me the PDM would be considered durable medical equipment (with 20% copay) and the pods would be considered supplies at no out of pocket cost to me. So I committed.
Then my insurance decided I had to go through a 3rd party vendor to get my pump and supplies. When I did, the supplier told me the pods would be considered durable medical equipment (more out of pocket). So I told them I would have to reconsider and look at other options.
The 3rd party vendor then called my insurance and said there was "another code" that could be used and the pods would be treated as supplies.
I've only reordered once but I had to have the same debate with the supplier when I reordered. This seems to be an area of confusion between suppliers and insurance providers so I would take advantage of that confusion and challenge them.
I mean how can something that you throw in the trash after 3 days be considered durable medical equipment?
Thanks for that advice, while my insurance company is my state (Oregon) high risk pool they subcontract to BCBS for admin. At present the state pool pays 100% of diabetic supplies (e.g. Insulin and test strips); obviously I would be a whole lot richer if I wasn't paying $1500+30% per year for my Omnipods.
I agree; there's no way even a lawyer could count a lifetime of 3 days maximum (well, ok, 80 hours maximum) as durable. Maybe they're doing this because of the medicare issue; that medicare does not pay for supplies?
John Bowler jbowler @ acm.org
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