How does your insurance bill your accessories and supplies

[Prettypistol]

Yes I know every insurance is different...

If you are willing to share, how does your specific insurance bill your accessories and supplies? (Not your actual cpap or Bipap machine)

Can some of you look at your eobs and enlighten me... this may help me or other people who are having issues having insurance code and bill properly regardless of having different insurance some kind of lists is bound to help someone ...

1. What insurance do you have ? Group ..state etc..
2. under what benefit do your supplies/accessories fall ? *example* are you paying your dme copay or deductable as if each supply (ex filter, mask, tube) should be subject to the same copay as your actual machine... ex. every time you get a mask your paying the same copay or deductable you would have on a machine
3. If you have your machine a year or longer are they billing supplies or accessories differently (ie you have proved complainace and whatever copay or deductable you have for a machine wouldn’t appply yearly since you already have the machine)
4. Do you have any policy documents that SPECIFICALLY points to how accessories for a cpap machine should be billed ?

[prodigyplace]

Yes I know every insurance is different...

If you are willing to share, how does your specific insurance bill your accessories and supplies? (Not your actual cpap or Bipap machine)

Can some of you look at your eobs and enlighten me... this may help me or other people who are having issues having insurance code and bill properly regardless of having different insurance some kind of lists is bound to help someone ...

1. What insurance do you have ? Group ..state etc..
2. under what benefit do your supplies/accessories fall ? *example* are you paying your dme copay or deductable as if each supply (ex filter, mask, tube) should be subject to the same copay as your actual machine... ex. every time you get a mask your paying the same copay or deductable you would have on a machine
3. If you have your machine a year or longer are they billing supplies or accessories differently (ie you have proved complainace and whatever copay or deductable you have for a machine wouldn’t appply yearly since you already have the machine)
4. Do you have any policy documents that SPECIFICALLY points to how accessories for a cpap machine should be billed ?

1. Anthem KeyCare 300 on Virginia. (DME is Lincare)
2. 20% copay, same as CPAP rent-to-own Now, own machine.
3. No change
4. They use the standard Medicare codes. I have found a listing of those online so I could cross reference to the items billed by Lincare.

Unfortunately when you order supplies from Lincare, without auto ordering, they still hound you with emails trying to get you to buy more supplies than necessary, just because insurance will cover 80% of it.

[LSAT]

Medicare has a 20% co-pay for ALL DME...DME covers a wide variety of items..Respatory, Oxygen, CPAP, wheelchairs, canes, walkers...all with a 20% co pay . I think many insurance companies follow Medicare guidelines.

[Okie bipap]

We also Medicare, but we also have Tricare for life which pays the Medicare copay amount. This makes our supplies cost free. I only order supplies when we actually need them. Our DME used to start calling as soon as we could order supplies. I asked them to put us on their no contact list, and I notify them when we need supplies. It has been almost six months since I ordered supplies (two mask cushions each). I will probably need to order supplies again next month.

[Cardsfan]

I have UHC- Choice Plus PLAN . MY EOB for 2 filters I just got says:
Type of service- "Medical supplies", cpap device filter.
2 filters
billed $20.60
discount -16.02
Plan paid $0. (because I have not met deductible)
I owe- $4.58

After I meet my deductible, I own 10%, plan pays 90%-- on everything in network. My machine was paid for the same way- I did not have to rent it and they did not monitor my compliance. My DME supplier is Lincare.

[Cardsfan]

what did you order and what were you billed?

[mesenteria]

Public Service of Canada Health Care Plan member as a retiree. We have a deductible we must pay, regardless of the item purchased, upon the first billing each year. Thereafter we are reimbursed at the rate of 80% for prescribed goods and services. My plan pays up to CDN$2000 for a first machine, and $189 for a first mask. Thereafter, per annum, we can be reimbursed a maximum of $300 total for replacement tubes, masks, filters, etc., again at the rate of 80%. We can get a new machine every 5 years and be reimbursed whatever their published rate is at that time. It's not clear to me that I would have to submit to another assessment or to submit another prescription.

[Prettypistol]

Does anyone have united healthcare choice in network (no deductable plan) through an employer. For example, we have insurance through sabres group plan. Yes I know insurance is different. Just wondering if someone has a similar plan

[Prettypistol]

Bump

[LSAT]

You haven't told us why this is so important to you. The way our insurance bills has no bearing on you.

[greatunclebill]

i also have medicare and tricare for life. medicare pays 80%, then tricare for life pays the 20%. tricare for life also pays the medicare deductible, so we pay nothing.

[jjc155]

well since my employer went from a plan where i had close to zero out of pocket to $12000 per year out of pocket I'll be looking for the cheapest online vendor for my stuff to save as much money for me as possible.

J-

[Prettypistol]

You haven't told us why this is so important to you. The way our insurance bills has no bearing on you.

Because at some point someone else’s information and or how there eob is billed and worded may help someone else get there own bill sorted - since lots of insurance company’s like to screw people over as much as possible. So seeing how supplies are coded and worded on other people’s eobs may help... it may also not, the point is having the information has its usefulness ...
I did however imply that in the original post. If you feel your information wouldn’t be useful don’t post a response at all.

[Cardsfan]

So how were your supplies billed and coded? Do you think the codes are wrong? It would help if you post some actual details of what you believe is wrong with your EOB. I've been trying to follow your posts- so far, you state that the Ins. co should cover your cpap supplies at 100%. What are you being charged? The billing could be correct code wise, the problem could be what the ins. co believes your contribution should be- is that it?

[sc0ttt]

Because at some point someone else’s information and or how there eob is billed and worded may help someone else get there own bill sorted - since lots of insurance company’s like to screw people over as much as possible. So seeing how supplies are coded and worded on other people’s eobs may help... it may also not, the point is having the information has its usefulness ...

You're right, it helps to see examples of other peoples' billings. This is from a few years ago, good plan with 20% copay and $400 deductible.
I paid the $150 at pickup, and the $317 a few weeks later when the insurance processing was done.