Omni pods and Humana


(Janice) #1

January 1, 2018 Omni pods were taken off the Medicare approved list, then on 1/10/2018 they were put back on , just not in the correct part. I tried to refill my Rx on 5/16/2018 and that didn’t work, Humana refused said it went against my plan. Maybe so but I couldn’t get an accurate reason why, so I turned them over to the Integrity division , they are the watch dog group for Medicare advantage plans. Found out today that there are 25 of us fighting this battle, I am sure there are more…I ran the risk of running out in 2 days and my supplier sent me some under the table and so did Insulet corp. Omni Pod mfg… If anyone else is having the same problem let me know and I’ll give you all the info I have, and who to contact. The feds didn’t know there were 25 of us possibly more now they do and they are taking a better look at the problem. I now have to appeal their decision again, they have been supplying me for 6 yr after I won the last appeal now they tell me that the win had a time limit, it was only good for 5 years, I don’t know if that means that everyone using an Omni Pod either by appeal of initial approval will have to re-appeal every 5 yrs. I should find out on Monday if the denial has ben overturned. Contact me if you need help. Bye Jan


(Marilyn123) #2

Hi Janice – I am an OmniPod user, too, but too young for Medicare, so I still use my private insurance. I was doing a bit of surfing on the web yesterday about the OmniPod and Medicare, and was shocked and distressed to learn that the OmniPods are going to be classified into Medicare part “D”. Financially, this is horrible news for me and may cause me to have to stop using the “Pod”. Private insurers almost always follow Medicare’s rulings, so I am afraid this will change for me, too, next year.

I believe Medicare needs to do this across the board – everyone [all brands of insulin pumps] or no one. It is not fair that only the OmniPod user should have the classification switched from Non Durable, when all the other insulin pump parts are still classified this way. Medicare should have approved the coverage under the Non Durable classification, just like it is for all the other brands.

I am an early retiree on a tight budget and this news is very, very bad. I hope things are better on your end, Janice!


(Marilyn123) #3

I meant Durable – ooops, Lol!


(Dennis J. Dacey, PwD) #4

Hi Marilyn @Marilyn123 , you may have seen that JDRF Advocacy as well as a few other groups is working to correct that issue and direct Medicare to properly serve beneficiaries. I’m aware that one of my Congressmen has spoken in favor and the two other have told me in email that they will act.
You must also be aware that when CMS [Medicare] approved use of the Dexcom G5 in November 2016 it required Dexcom to do some reprogramming so readouts could not be sent to anything other than the Dexcom Receiver - the DME piece of the system. Now that CMS has taken approval of the G6 under consideration I hope that they might act logically.
The boxes holding the modified CGM have “Medicare” in bold print - the monies I paid into Medicare since the 1963 law went into effect, and still pay monthly, appear to make me a second-class citizen.


(Janice) #5

Marilyn, good to hear from you, here is the latest as of last night. The Rep from Insulet corp here in Az. called me to see if I had received the package of pods she overnighted me, since Humana said no. Wed discussed the part D thing and they (Insulet) are trying to get things changed… Medicare covers all pumps, when I talked to them the other day, the call center( that’s who everyone gets when you call) doesn’t recognize any difference between pumps as far as they are concerned all pumps ae the same. I don’t know wo started the problem and if I was a conspiracy theorist I ‘d say it was the other Mfgs. Because Insulet must have a patent on the mechanics. The Doctor that is deciding my case told me when I told her why I used the Omni Pod that there were other tubeless pumps she named some names. I went looking and all those she named were for type 2, so I called her back had to leave a voice mail telling her that these were not appropriate for type 1. The scary thing for me is that I think she is a GP not an Endo and her knowledge is limited (my impression) due to her confusion of the pumps. My Endo will set her straight. The funny thing is that with me being a type 1 for 64 years I am sure I know more that she does, and she reacted to me as if I don’ have a clue because I am not a doctor. My Endo will tell the Doc. to ask me because I am constantly educating my doctors, they like the education… If the decision still comes back denied, my attorney handle it. I am so thankful that Insulet Corp and CCS Medical thought enough of me to come to my rescue. Ps: I e-mailed Pres. Trump regarding this Medicare problem I am not against some tricks and I also signed the petition that went to Senators and The Pres. Don’t panic Me and A lot of others are trying to fix this problem. Enjoy life and don’t sweat the small stuff until you have too. A lot f us ae trying very hard to fix this before it gets to you… Just say a little prayer and keep your fingers crossed. When I win I’ll let you know how, just in case. Have a great day. Bye for now Jan


(Janice) #6

Hi Dennis, Never A Second Class Citizen. went shooting today had a great time. Shot with a 22 rifle with a scope at a target 25 yards away missed the bulls eye by 3/4 inch, first time with a rifle and this was for a gift card, don’t know if I won any or not but I was quite proud of myself, my husband said he didn’t think I could see that far, let alone hit anything, think he was proud, not sure., I was proud. not to brag, but it was fun. Have a great day Bye jan


(Dennis J. Dacey, PwD) #7

Hi Jan @JaniceD - this is out of topic on the current post, Omni pods and Humana. We will have to put this elsewhere.
It is what the TON Guidelines consider “hijacking”.


(Janice) #8

Sorry, I don’t understand, aren’t we supposed to help others, where else should I have put it? Was told there were others in this boat but the feds were unaware of this fact, now that they know they told me that if this was becoming a standard operation that they needed to know in order to stop it. Sorry if I screwed up. Bye Jan.


(Janice) #9

Dennis , when I posted this similar items re: Omni pods were in the General category, I checked there first. But if this is not correct and I am being restricted. “TON -Hijacking” don’t understand… Don’t need this, it’s been fun. have a great life, I am out of here. Bye jan


(Dennis J. Dacey, PwD) #10

Jan @JaniceD this is the post to which I made the comment. Shooting a rifle isn’t usually in the same context as OmniPod.


(Janice) #11

Sorry, I was responding to your earlier post, won’t happen again. People don’t have to read it but it shows that some of us are not home feeling sorry for ourselves, and you know the group I go with we are a mentoring group , and we are the only group out there that mentors those in our conditions. SORRY it upset anyone. As I said Bye Jan


(Marilyn123) #12

Hi Janice! Good to hear from you! I happen to live in Arizona, too. Small world!!! My main concern is that these pods stay classified in Medicare DURABLE goods, like the other brand pump supplies. If they are put into Part “D” they will be very costly. They need to be treated just like the other insulin pumps. I am due to get a new one [which is why I was surfing the subject anyway] and now I am afraid to get a new one. I think I will try and hold off until this is resolved…You have had your T1 a long time - 64 years! I am further behind you – 40 years – I picked mine up at 22 – just out of college, married less than a year, got pregnant and 2 weeks later diagnosed with T1 diabetes.Emoji. Are you in the Phoenix area? Maybe we can get together for lunch someday! Have a nice day and thanks for the info!


(Janice) #13

Marilyn, I am in Phoenix, 19th ave and union hills. If the doc. rules against me, the first thing Iam going to do is find out if she is an endo. if she isn’t then she is not qualified to make this decision and a friend told me of an atty that deals especially in this type of thing. I was 9 diagnosed back in the dark ages… I wouldn’t hold off, but I don’t have a choice. If the doctors making these decisions for the insurance companies, and they are not qualified, that’s great, the atty will love it. Per Medicare they really don’t see a problem all pumps are the same according to them, it’s the way the ins. co. interpret the rules, it’s all in the language. Lunch sounds great, but I had to give up driving when I became an amputee, no not because of the diabetes, and every time I mention going back to driving my husband turns this deathly shade of pale, I try to cut him some slack once in a while…Lunch will be fun. Have you talked to Insulet Corp regarding your concerns? When I just ran out of pods this week they sent me 2 weeks worth till this thing with Humana gets settled… I am in the phone book Janice Eastman Keep in touch jan PS: The group I’m with for fun is “the Next Step Peer mentoring” check us out on facebook. Taught me how not to be a victim- after all, older lady, wheelchair, amputee perfect victim, not me. bye again


(Marilyn123) #14

Hi Janice. You are not too far from me at all - I live in Glendale near 59th and Peoria. I am on FB - Mailyn Hewitt, the one in AZ. I am sitting in my garden, just a pic of me. It is easier to pm on there. No, I have not contacted Insulet yet.


(Janice) #15

Hi Marilyn, Insulet Corp called me to see if I had received an answer re: my immediate appeal, told her no and I asked her about your situation, hope you don’t mind, she said that you need to refill your order and not hold. It seams that that the other Ins. co. that ae covering the Omni Pods will continue to do so. Re" Part D. Insulet Corp is going around to all the other ins. co to make sure they understand why the designation is part D. at this time, hopefully things will get squared away this year… She knows that I called the Feds on this situation since thee are so many of us, curious what they (Integrity Division) are going to do. I am sure I’ll get a call. I’ve done all I can for all of us in this boat, now I need to wait for a decision before I proceed…Hope this is OK with you. Bye Jan


(Janice) #16

FIY-Good News- got word this afternoon I won my immediate appeal for my Omni pods, The strange part is that Humana put a time limit on my win- It’s only good thru 12/18 don’t really know if this is legal, I need to check it out. FYI: for those of you that have to appeal your health insurance company’s decision… it seems that the doctors that the insurance companies bring in to question your need is usually a GP and it you have Diabetes or any other serious disease the GP is not qualified to make the life and death decisions but so many people get the decision and don’t question the person making the decision, just went through this with my own appeal and I let it be known if it was denied I would definitely question the qualifications of the person making that. decision, I am good thru Dec. unless I can get the decision made permanent… Bye Have a great day jan


(Janice) #17

Marilyn, couldn’t find your phone listed- e-mail me if you want janeastman@q.com


(Marilyn123) #18

Hi Janice! Hope you are well. It is a busy week for us – we have VBS every night this week and they have a supper right before, so that is nice. Keeping us out of mischief, LoL. Didn’t get home until almost 9:00 last night. I think I am going to try and nurse along my old OmniPod and not order a new one, until I get my Open Enrollment materials from work, in late November. Just because, I don’t want to take a risk with being forced to buy OmniPod supplies if they switch to the Drug category. I would need a lot more information on the cost before I would commit to such a high monthly/quarterly bill for something I now get free…Janice, I looked for you on FB but could not find anyone with your name, except a lady in a different town [Fountain Hills]…I hope you are having a good week - Marilyn


(Janice) #19

Marilyn and anyone else Regarding the problem with Insurance and Omni Pod coverage. I got a letter from Humana when I questioned my new Co-pay for the Omni Pods, used to be $291 for 90 days as of yesterday now my co-pay is $1540.00 for a 90 day Rx. Also it seems that if I want to run it through my Ins. I can only purchase them from the Humana Pharmacy they have shut down all the other suppliers here in Az. If I want to pay cash, cash price is $900 for 90 days and I can get them from Insulet corp…I think this is a monopoly and also discrimination against seniors since it’s a Medicare problem. I filed a complaint with the Az. Atty Gen for monopolizing our suppliers and not giving us a chance to find a better price. Hopefully he will investigate. Any one with suggestions please let me know, next step may be the news, like the Epi Pen problem. I can use all the help I can get. Have a great day, bye Jan PS: our congress man is useless.


(Marilyn123) #20

Hi Jan –

People with chronic diseases cannot afford these kind of payments.This extreme price change will make the national news.