Newbie To Having Insurance. Have Questions.

Ok. I'm 33 years old. I'm getting insurance that goes into affect March 1st. My plan will be BCBS PPO in Texas. This is the first time I have had insurance..... My plan is Zero Deductible, 500 out of pocket before insurance kicks in 100%, I think cpap stuff is 80% reimbursement.

Obviously I will give them a call come March 1st for info but I had some questions that maybe someone could help explain before then.... I'm already on cpap. I have been for years. I had a sleep study like 10 years ago. I really really want a new CPAP machine!!!!!!


1.) Do you think my insurance will want me to have a new sleep study if there gonna start to pay for things?

2.) I hear people say "DME".......this is a company your insurance gives you to get your cpap supplies/machine from that deals through your insurance.... Is this correct?

3.) To get cpap supplies/machine through your insurance You Have To Deal With A DME??????

4.) I can buy stuff from cpap.com but will have to file a claim my self/can this be done???

1.) Do you think my insurance will want me to have a new sleep study if there gonna start to pay for things? Maybe, You'll have to ask them.

2.) I hear people say "DME".......this is a company your insurance gives you to get your cpap supplies/machine from that deals through your insurance.... Is this correct? Yes. DME stands for Durable Medical Equipment and most insurers require you to go to a DME supplier they are contracted with to get your equipment. So be sure to ask your new insurer for a list of DME's they contract with. If you go to a DME they don't have a contract with you may have to pay more or pay it ALL out of pocket, depending on the insurance.

3.) To get cpap supplies/machine through your insurance You Have To Deal With A DME?????? Maybe--SOME (not all) insurers will reimburse you if you order online from some place like cpap.com, but ASK first, don't assume, because only a few will do it.

4.) I can buy stuff from cpap.com but will have to file a claim my self/can this be done??? See above, it depends on your insurer.

IF you can use cpap.com, and can afford to be reimbursed later.... that's the best way to go. I'm in no way pushing for cpap.com, but it will save a lot of frustration and headaches if you do. I deal with Apria (Crapria) because I have to.

Just sayin'

Sheriff

[quote="Sheriff Buford"]IF you can use cpap.com, and can afford to be reimbursed later....


Yeah NoI I can't afford to do that..... This whole insurance thing sounded good at first but it might just be a pain in my ass

Talk to BCBS as soon as you can and remember cpap.com will never be in network for BCBS TX (I have it) so will always be 100% out of pocket. Unlikely it'll save you money but maybe save you hassle.

When I had BCBS, the deductible and copay for out of network were double the in-network amounts!
Just about like no insurance at all, but every plan is different,
--management may even have a different plan than peons.
Get as detailed a summary of benefits as you can, on paper!
--from your benefits manager at work, or direct from the insurance company.

chunkyfrog wrote: --management may even have a different plan than peons.

While this is possible, if the group health plan for management is better than the "peon" plan, then the company can be hit with excise taxes of $100/day/peon (a HUGE fine). So, as a general rule, companies don't do this. They may provide some additional benefits to top executives outside of the normal health plan, but in general management and rank and file will have the same basic plan choices. Another exception to this is if you work for a franchisee of a major brand - people who actually work for the corporation may have different benefits than those who actually work for the franchisee. The same thing applies for a subsidiary of a larger company - the subsidiary may have different benefits than the parent company.

You definitely need to ask lots of questions and get actual numbers before making a decision. Having insurance sounds like a great deal but the problem is that everything bought with/through insurance uses the artificially high insurance list prices. Sometimes, it's so crazy that your co-pay can be equal or close to what you would pay to just buy a machine without insurance! It's crazy, but true. Get pricing from whomever they want you to buy the machine from - bottom line, what do you pay and when? Then, go to cpap.com and secondwind.com and find out how much that machine is sold for there - without insurance.

Many of us end up buying used machines to save money via craigslist or secondwind.com. This is lots more work and requires great care and research but can save lots of money. I was lucky to get the system in my signature for $100, but I haven't seen another deal as good since. $200-$250 would be more typical on craigslist for an older machine while a brand new recent model might go up to $750-$1,000 or so.

Also, you need to watch out for another pitfall in the system. The insurance company usually pays the DME a fixed price for the equipment code "cpap machine" - whether it is the cheapest, dumbest, simple, no-data machine or a top-of-the-line, data-capable, auto-adjusting machine. When this is the case, the cheapest machine they can get away with giving you means more money in the DME's pocket. Some system, huh?! What is best for YOU is to get a data-capable machine so you can monitor your progress and that can automatically adjust to your changing needs instead of having to go back to the doctor and/or DME again and again. So, collect all the information you can get on what they propose giving you and what it will cost you to get it. Get the actual model numbers as the names are intentionally similar with only a often single word difference between the dumb and smart models. Then, come back and ask for advice.

Here is the page about cpap.com and insurance . It
looks like they are very open about not supplying much
or any help with your insurance to keep cost down.



https://www.cpap.com/cpap-faq/Insurance.html

Woody wrote:Here is the page about cpap.com and insurance . It
looks like they are very open about not supplying much
or any help with your insurance to keep cost down.

if they were to provide that help, the salaries of the additional people required to navigate the insurance morass would have to be passed on in higher prices.

Just remember that a there will be discouts if you use a DME that is on your insurance carrier's approved list.

I work for a large blue insurance company and the discounts are worth the "pain" of working with your insurance company.

Thanks for the info everyone!! I will for sure be asking my Insurance a Lot of questions. I think I found a website that might work with insurance called Easybreath.com

Easybreath.com is a little bit more expensive than CPAP.com, but if your insurance will work with Easybreath and not CPAP.com, it may be worth it.