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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
fivepointpack
 
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Website to purchase that also accepts insurance

Postby fivepointpack on Mon Mar 20, 2017 1:38 pm

Hi all, my first time on and posting. I have looked at websites like easybreathe.com, etc that say they accept insurance, but typically halfway through their "vetting" they just say no insurance is needed to purchase, not that they cover anything. I am looking to see if there are some suggestions there for sites to purchase from that will file this to my insurer and bill that way?

Let me know, thanks!

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Pugsy
 
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Re: Website to purchase that also accepts insurance

Postby Pugsy on Mon Mar 20, 2017 1:46 pm

You need to start with your insurance and ask them for a list of DMEs or cpap suppliers that they have contracts with and then start checking to see if they have an online website you can order from.

We could give you a name but we don't know if they are part of your insurance network and you want someone in your network so you don't have as much copay.

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Janknitz
 
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Re: Website to purchase that also accepts insurance

Postby Janknitz on Mon Mar 20, 2017 1:47 pm

You need to call your insurer and see if they work with any mail order suppliers. If they don't have any specific suppliers, then ask if they will reimburse you for purchases made from online suppliers and what documentation is required.

There are some online suppliers that will work with some insurers. Libertymedical.com comes to mind. I don't know anything about the quality of the company so I'm not endorsing them, but if YOUR insurance doesn't work with them it doesn't matter if they accept some insurers or not.

You should also get some other basic info from your insurer before you start ordering equipment and supplies:

What is your coverage? (100%, 80/20 if you use a preferred provider or any provider, no coverage)
Do they pay by HCPCS codes (billing codes, which means they will pay for ANY CPAP/APAP machine).
Do they require you to rent the machine perpetually, rent for a period of time (called a "capped rental") or do they cover an outright purchase.
Is a contracted provider allowed to do "balanced billing" (that is bill you for the difference between the DME's outrageous fantasy price and the contracted price they have agreed to accept from the insurer. Most states and most insurers do NOT allow balance billing).

Know exactly what machine you want (make and model) before you place an order, so that you won't get stuck with a brick. See my blogpost "What you should know BEFORE you meet your DME" so you don't get suckered.

Good luck.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

fivepointpack
 
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Re: Website to purchase that also accepts insurance

Postby fivepointpack on Tue Mar 21, 2017 6:25 am

Thanks all. I spoke with my provider (BCBS) and they were unable to pull the recommended frequency for the CPAP portion of their DME program. Troublesome, but I think once I can just get a reputable DME source, they should know the procedure on how to file and figure out what I have covered. They noted Aeroflow as one possible site, and I have e-mailed them to find out options.

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Re: Website to purchase that also accepts insurance

Postby Guest on Tue Mar 21, 2017 5:54 pm

fivepointpack wrote:Thanks all. I spoke with my provider (BCBS) and they were unable to pull the recommended frequency for the CPAP portion of their DME program. Troublesome, but I think once I can just get a reputable DME source, they should know the procedure on how to file and figure out what I have covered. They noted Aeroflow as one possible site, and I have e-mailed them to find out options.


Apria is the only place that gave me correct information regarding my insurance, Tricare Prime. I was questioning why they were giving me supplies more often and was told because I qualified for them through my insurance. I called my insurance and verified the info. This discovery led to me realizing that my local provider was not following protocol at all on it. I am getting replacement supplies in half the time I was getting them before. Check out Apria online, they are national and you can call them too.

D.H.
 
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Re: Website to purchase that also accepts insurance

Postby D.H. on Wed Mar 22, 2017 2:15 pm

No U.S. insurer will pay for a CPAP without a prescription. The only possible exception I can think of is if you're replacing an existing CPAP, but I'm not even sure about that.

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Re: Website to purchase that also accepts insurance

Postby Guest on Wed Mar 22, 2017 5:48 pm

D H. wrote:No US. insurer will pay for a CPAP without a prescription. The only possible exception I can think of is if you're replacing an existing CPAP, but I'm not even sure about that.
Did someone mention not having a prescription but expecting insurance to pay?

fivepointpack wrote: I spoke with my provider (BCBS) and they were unable to pull the recommended frequency for the CPAP portion of their DME program.
That makes me think they want to replace things when they fail only and not on a schedule which is the way most insurance is going these days. Call back on a diff day and/or time get a diff agent get a diff answer just ask for it in writing.

I would avoid Apria at all cost, esp. giving them a credit card. You must have other options?

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chunkyfrog
 
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Re: Website to purchase that also accepts insurance

Postby chunkyfrog on Wed Mar 22, 2017 6:36 pm

" . . . A REPUTABLE DME"?
OMG! You made such a funny. :lol: :lol: :lol: :lol: :lol: :lol:

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palerider
 
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Re: Website to purchase that also accepts insurance

Postby palerider on Wed Mar 22, 2017 6:50 pm

chunkyfrog wrote:" . . . A REPUTABLE DME"?
OMG! You made such a funny. :lol: :lol: :lol: :lol: :lol: :lol:

those and unicorns.

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Janknitz
 
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Re: Website to purchase that also accepts insurance

Postby Janknitz on Thu Mar 23, 2017 2:06 am

" . . . A REPUTABLE DME"?

They'll be happy to sell you a bridge in Brooklyn. :wink:
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm


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