Blue Cross/Blue Shield

[Jason S.]

I am BC-BS FEP. My MD sent me to a sleep center, I never checked to see if they were in or out of the plan. How many sleep centers can there be in town? I had to pay about $220 for each sleep study, which I think was about 10% of the cost, and 10% of my CPAP and supplies. My deductible for 2008 had already been met. The insurance company then sent me a check for only about 50% of the bill that was submitted to them (all they cover for out of plan), which was over double the price that was quoted to me. What's going on? DME tells me the equipment cost $1700, tells me to pay $170, then bills the insurance company for $2700? I called the DME and they said they would write off the amount I "owed", which was about $1500. Today I called the DME and they said they covered 90% of replacement supplies. I guess I don't trust them and will call the insurance before I unknowingly commit myself to a huge expense because of their bad information.

[Wulfman]

I am BC-BS FEP. My MD sent me to a sleep center, I never checked to see if they were in or out of the plan. How many sleep centers can there be in town? I had to pay about $220 for each sleep study, which I think was about 10% of the cost, and 10% of my CPAP and supplies. My deductible for 2008 had already been met. The insurance company then sent me a check for only about 50% of the bill that was submitted to them (all they cover for out of plan), which was over double the price that was quoted to me. What's going on? DME tells me the equipment cost $1700, tells me to pay $170, then bills the insurance company for $2700? I called the DME and they said they would write off the amount I "owed", which was about $1500. Today I called the DME and they said they covered 90% of replacement supplies. I guess I don't trust them and will call the insurance before I unknowingly commit myself to a huge expense because of their bad information.

More LIARS! The DMEs typically have a contracted price with the insurance providers or go by Medicare/CMS pricing guidelines. Notice I said "typically".......there are always exceptions to many rules, but this may be what's happened in your situation.

Den

[old64mb]

The insurance company then sent me a check for only about 50% of the bill that was submitted to them (all they cover for out of plan), which was over double the price that was quoted to me. What's going on?

Your DME is probably an out-of-network provider to BC/BS, which means that they don't have to follow their pricing rules and like most DMEs, will jack up prices to absurd levels if they can get away with it (e.g. no contract with insurance company that forces them to get reimbursement at that rate). You actually got unlucky and lucky; someone probably quoted you the in-network rate for another insurance company (unlucky since you could have saved the headache by learning they weren't in-network and going elsewhere and saving money by shopping online if you wanted), but they did write down the bill so you don't have to take them to court on enforcing that quote (lucky, the real scumbag DMEs would have insisted.)

Personally, I hate Wellpoint's licensing of BC/BS and think their SDB coverage isn't particularly good, but that's a long story.

One bit I will share is that as of a few months ago they have zero, nada, no sleep labs or doctors listed as being in-network in California, so I initially even wondered if it was a benefit. Had to do a ton of research to avoid your fate - ended up giving BC the tax IDs of the center to confirm that I was ok going there. Maybe they've finally updated it, but what I've learned since then is almost all insurance companies require AASM-accreditation to cover a lab in-network, so looking them up on the AASM sleepcenters.org website is a good first test for anyone in the future who needs to find out if they're going to get covered.

[Jason S.]

One bit I will share is that as of a few months ago they have zero, nada, no sleep labs or doctors listed as being in-network in California, so I initially even wondered if it was a benefit. Had to do a ton of research to avoid your fate - ended up giving BC the tax IDs of the center to confirm that I was ok going there. Maybe they've finally updated it, but what I've learned since then is almost all insurance companies require AASM-accreditation to cover a lab in-network, so looking them up on the AASM sleepcenters.org website is a good first test for anyone in the future who needs to find out if they're going to get covered.

I searched BC-BS FEP and there are no sleep centers in network within a 100 miles radius. The insurance company would consider that in charging the the lower "in network" rate for the sleep study. However, my issue is that the DME shares the same office space as the sleep center, so naturally they hooked me up to the DME, as if in nepitism. I was like a sheep being led to slaugter. I found out there are other DME's in my area that are in network. Too late, I bought my equipment, and the difference in my cost is 30% vice 15% PLUS the COINSURANCE, which is really the big piece, $460 in the case of my cheap-ass, bottom of the line CPAP machine. At least I think I can get replacement parts with the in-network DME as long as I send them all my info.

[SaltLakeJan]

I have Blue Cross Blue Shield in Utah, they would only pay for a sleep study if it was done in a fully accredited sleep lab & separate from a sleep doctor's office.

[SaltLakeJan]

To be certain they would pay, I called Blue Cross with the name of the sleep lab. I knew it was expensive, & I didn't want to have to pay, and not have them accept the results. Good luck in Texas

[nate fry]

I have blue cross and they just spent 120,000 on my surgeries and hospital stay, It took a month to clear it but when they did no problem. My cost ) % nate