Omnipod coverage and United Healthcare


(srscott12) #1

Has anyone else had recent issues with United Healthcare covering Omnipod pod supplies? I’ve worn the Omnipod for 7 of the 8 years I’ve been diagnosed, and it works so well for me. I can no longer get pharmacy coverage and pay the copay for pods, as they’re now considered “non-formulary”. DME costs are outrageous through my insurance (paying $500 or more for a couple boxes of pods).

I know that UHC has Medtronic as it’s preferred pump (another issue entirely for the T1D community), but has anyone had success staying on Omnipod with UHC as an adult patient? I’ve contacted my local Omnipod rep, Insulet corporation, and spoken with many people at UHC, as well as my doctor’s office - feels like I’m running out of options and will be forced to switch to shots or a different pump soon.

I appreciate any suggestions or tips others have had success with navigating the insurance nightmares.


(Dennis J. Dacey, PWD) #2

Hi @srscott12,
I don’t use Omnipod so I can’t directly give you a boost, yet I know many people here have success having that device covered by insurance.

Your DME comment hits the nail on the head - maybe United Health is taking that stance. For instance Medicare can NOT make any reimbursement to beneficiaries for expenses relating to Omnipod because it is a “throw-away” and not durable. Durable must last some length of time.