Kaiser Permanente HMO coverage of Omnipod


(MARK) #1

My daughter is looking at switching to Kaiser Permanente HMO of Georgia. She has used Insulet Omnipod for years. Can anyone covered by Kaiser Permanente who uses Omnipod share their experience and advice with regard to coverage? Does KP HMO cover Omnipod? If so, what do we need to know in order to ensure smooth handling of the administration of claims, preauths, or whatever in order to establish coverage of Omnipod with KP HMO? We are currently with Blue Cross Blue Shield and we have coverage for Omnipod, but we do have a lot of issues working between Edgepark, the PCP, and BCBS to get preauthorizations and to work to correct denials due to no preauth.


(Dennis J. Dacey, PwD) #2

Hi MARK @mmbowden, having worked with insurance plans I can tell you that there are many differences between plans with the same name. This would be foremost is what she is looking into is an employer sponsored plan; when I was in corporate risk management we were actually “self-insured” and had Major Insurance Companies front for us and process claims in accordance with our set coverages.

I would strongly urge your daughter speak directly with the “claims department” at Kaiser about her particular [proposed] coverage. Another route, speak with the OmniPod marketing team and let them push her coverage.


(MARK) #3

We just spoke to Kaiser Permanente HMO about coverage for Omnipod. Specifically, we called the contact for KP of Georgia (front for the State of Georgia Healthcare Benefit Plan or SHBP). SHBP serves State of Georgia employees including teachers. KP HMO stated that Edgepark is an approved provider and that Insulet Omnipods would be covered as a DME (Durable Medical Equipment). I’ve seen posts elsewhere on this site that some individuals have had trouble with at least one healthcare provider that classified Omnipod as DME since Omnipod is disposable (not durable) and new pods need to be reordered every 3 months or so. We need to ensure that KP of Georgia will work smoothly (as possible) through the ordering process. A little history… With our current provider, Blue Cross Blue Shield (also Georgia’s SHBP), we have had a great deal of difficulty with preauthorizations needed for coverage of Omnipod. It involves 3 parties; the doctor, BCBS, and Edgepark. We are on the phone with all 3 repeatedly. Some orders have been covered, and others denied due to no preauthorization. Still working on that one for this year.


(MARK) #4

We spoke to the representative that answers the phone for enrollment period questions. See my post regarding the answer we were given. I’ll look at calling back to talk to a “claims representative”. Thanks for your input!