Blue Cross of California blues

Hello

Had my first sleep lab study done in November 2006 (a two night study one without cpap and one with cpap) The company i work for is affiliated with an administator and the carrier is a PPO plan with Blue Cross of California my share is 20% and the insurance covers 80% no problems in 2006 Blue Cross covered 80% of $1,700.00 for each test. Went back at my sleep Doc's request in December of 2007 for a re-titration and was horrified to find out after the test when the lab's billing dept. called that Blue Cross changed the rules so to speak and no longer covers sleep tests or retests (not sure which). After much haggling between the sleep lab and Blue Cross, the sleep lab decided to knock off the 80% that the insurance would have covered and i only had to pay 20% of the bill (thank god) i went online to the Blue Cross site and tried to research their coverage on sleep studies and equipment with no luck. Does anyone have any current info ? I would telephone them but would probably wind up getting mad and frustrated. Got a new Bi-Pap on a rent to own basis and had to pay 20% up front and six months rent at $54.00 a month to own it. Paperwork i recieved from the DME provider appears to show payment recieved from Blue Cross so they must not have a problem with paying for the machine. It appears that any future request's by my sleep Doc to be re-titrated will have to be denied by me as this is an expensive proposistion and i can not afford it.

Dale

I have no problems with BC/BS FEHB. But beware of APRIA RIP-OFF!
And then if you get put on disability after 26 months the put you on Medicare, then 13 months after that you get stuck with part B.
Enjoy your new machine they are great I have one.

I thought they just got sued for millions for doing that bait-n-switch tactic, I'm sure they have appealed that decision and will drag it out for years (because they have lots and lots of money (yours) and attorneys).

I used to have that BC catastrophe coverage, cost me $190 per month, it didn't cover much of anything, no prescriptions, no DME basically it only covered you if you had a heart attack.

I dropped it a couple years ago, so far I've saved more than $5,000 in premiums and spent $85 on doctor visits since then.

If you have BC it is probably because you don't have any other choice, but them sleep labs and doctors already know they should get "pre-approval" for any of those procedures, if you get slapped with a huge bill dispute it that it was their fault for not getting pre-approval, it is THEIR job.

Only thing bad is medical gets your SS# and trust me, they won't hesitate to ding your credit history file, but if you went to court over it, they would lose because it is common practice and knowledge that they should have gotten pre-approval before the procedure was performed and/or told you how much your portion would be.

O.K.

Before i had this last sleep test i had a phone conversation with the sleep lab billing dept. about insurance coverage and i was given some insurance code numbers and the lady i was talking to told me to call (the plan administrator) and give them the codes to see if they would cover the cost. I thought to myself that's your job lady and i didn't call, when i showed up to do the sleep study i asked the girl who works the front desk if i was covered and she said don't worry your covered the insurance approved you. Now it really sounds like the lab is shady also, and because they did not get pre-approval like Snoredog said they are supposed to do (which obviously they didn't) they got caught with the hand in the cookie jar and thats why they knocked off 80% of the bill. As far as prescriptions, dental, vision etc. the company i work for has other insurance companies cover those expenses but its all administrated through the plan administrator. And Patrick my wife is on SS disability and gets medicare benefits and probably because i have her covered under my insurance, they deny every claim and rarely pay. My wife has had some serious health problems recently and Blue Cross has always paid 80% of her bills and they rarely deny claims. Its just this last sleep study i had where i ran in to problems, other than that i have had no other problems with BC California.

Dale

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