| Insurance and CPAP questions advice (Capri) (Insurance and the CPAP Industry) |
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Insurance and CPAP question
It would seem, with all respect, that you are putting the cart before the hose ... I mean horse!
You should first become familiar with the world of Durable Medical Equipment (DME) suppliers and insurance. Until then, you may want to ask for a loaner or rental machine or buy an older one cheap on the auction site because this is going to take some time. Now get out your health insurance certificate booklet and read about your DME benefits. Find our your coverage for this type of equipment, along with your deductible, copays, coinsurance, necessity of physician referrals and annual/lifetime maximums.
1. Ask your prescribing physician to write a prescription that is as specific as possible, specifying what your xPAP and supplies need to do for you, e.g. a full-faced mask or a heated humidifier. Do not bother with brands at this step.
2. Get a referral to a good DME provider. Your visit there should be free. Interview them, identifying your expectations and any special needs. Now you will need to provide them with your Rx and a copy of your sleep study results. At this point you can get into such issues as brands and accessories.
3. This is important and takes some time. With your DME representative, submit the list of equipment you want to your insurance company for Precertification.. You don't want to have any surprises or get burned when buying xPAP equipment from a DME dealer. You could get stuck for literally THOUSANDS of dollars! Do not proceed until you receive precertification IN WRITING back from your insurance company. I called Blue Cross and asked to speak with an agent who is familiar with CPAP. They referred me to one who was on CPAP herself! She understood the importance and urgency of my request, and walked the paperwork through precertification. She was very excited and proud when she called me to let me know she had just faxed the precertification to my DME rep.
4. Now you're ready to get your xPAP and supplies. Now simmer down and don't go wild. Assuming you have to pay a portion of the expenses, buy a machine that has features you will use or anticipate doing so. Ultimately they all blow air, some quieter, some louder. When you can get an entire setup for around $500, your 20% coinsurance will be significantly less than if you go for a setup for 2 grand - and more!
5. Like any major purchase, ask about their return policy. It's an electronic device - get a good surge protector before you go out and get a snuggy hose with kittens printed on it. Finally, use common sense setting up your equipment so you don't step on your mask or worse.
6. Now, if you have any money left, go ahead and accessorize.
There is a wealth of information on this site and others. If you get the right machine and then find out your insurance won't cover it, you're not going to sleep much better anyway!
Cheers
Settings: CPAP 12cm, heated humidity, AHI=29
Main unit: ResMed S8 Elite, ResMed Humidaire 3i
Backup: ResMed S6 Lightweight, ResMed Sullivan Humidaire
Mask: ResMed Ultra Mirage FF
Backup: ResMed Swift II
Health Tools: ResMed ResScan Data Card, CMS-50E Pulse Oximeter, OneTouch Ultra glucometer, Citrus II spray mask cleaner
Software: ResMed ResScan 3.3, OneTouch, SP O2 Manager/Review |
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