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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Paul56
 
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Location: Texas
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Blue Cross/Blue Shield

Postby Paul56 on Mon Nov 03, 2008 6:20 am

More out of curiosity than anything...

I am currently living in Canada (Ottawa) and expect to be moving with my company to Texas (San Antonio) at some point in the next year.

We have setup with Blue Cross/Blue Shield in Texas for medical benefits.

In your experience how are they to deal with in terms of sleep apnea and getting your equipment?

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: AHI ~60 / Titrated @ 8 / Operating AutoSet in CPAP mode @ 12

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cflame1
 
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Re: Blue Cross/Blue Shield

Postby cflame1 on Mon Nov 03, 2008 6:23 am

Can't speak about TX in general... but BCBS is usually the easiest thing to use... easy to find providers etc.

_________________
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Humidifier: PR System One Heated Humidifier
Additional Comments: also have various other masks and a Legacy Remstar Auto Bipap with BiFlex

cpapguy2
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(sleepytexan)
 

Re: Blue Cross/Blue Shield

Postby cpapguy2 on Mon Nov 03, 2008 6:50 am

Just got my unit about a month ago through BCBS here in Houston. The paid 100% for both sleep studies but the complete unit came out of my deductible (which is pretty high!. :( ) Hope that helps with expectations...

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Dennisla
 
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Re: Blue Cross/Blue Shield

Postby Dennisla on Mon Nov 03, 2008 6:51 am

I have BCBS in Mass.
This is my coverage. And you decide how and where it is spent.

Benefit for Durable Medical Equipment
Benefit Limit: $1,500 per member per calendar year
Member Cost: No cost / No copay

-Dennis

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GuyK
 
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Re: Blue Cross/Blue Shield

Postby GuyK on Mon Nov 03, 2008 7:08 am

First of all -- I'd like to point out that there are several BCBS companies. For example, I am now under an HMO that is part of BCBS-Massachusetts. In the past, I've also been under Anthem BCBS (a New Hampshire employer) and will be moving to Anthem BCBS this next January (change of medical plan from my employer). You most likely will be covered under BCBS of Texas, as a guess, and their website and policies may be completely different than what I have experienced.

My coverage under my BCBS HMO has been great. The only snag in the process is that one has to have a PCP who refers to a sleep specialist. After that, everything has been covered: one sleep lab visit for PSG, one sleep lab visit for titration, followup with somnodoc, referral to DME and R/T. In my case, APAP fully covered (I've seen no bills or copays or anything), masks and supplies (I'm on my original setup, so I haven't tested any of this yet).

I had one small glitch: on the BCBS website, there is a "medical policy" which lists treatment and coverage for OSA. That policy says "APAP coverage only on failure of CPAP". My somnodoc told me he was prescribing APAP, and I mentioned the policy. He said he would let the DME deal with that. When I spoke with the DME, they told me that I was fully covered for APAP. A non-issue.

So, everything has worked out fine for me, and I've only paid $40 out of pocket so far (two $20 copays for somnodoc office visits).

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Additional Comments: ResScan 3.5 and card reader
Ready to fight the forces of evil, right after I finish this nap...

BeanMeScot
 
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Re: Blue Cross/Blue Shield

Postby BeanMeScot on Mon Nov 03, 2008 7:42 am

I am moving to BCBS of Omaha in Jan. I am also unsure what they will cover. We got our benefits guide last week but it doesn't mention DME.

BeanMeScot
 
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Re: Blue Cross/Blue Shield

Postby BeanMeScot on Mon Nov 03, 2008 10:34 am

They cover preventative medicine at 100%. I wonder if they include CPAP as preventative? It is.

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Paul56
 
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Re: Blue Cross/Blue Shield

Postby Paul56 on Mon Nov 03, 2008 11:30 am

Okay, thanks for the comments folks.

It will all depend on what kind of a plan we have and what corners they cut to keep the expense down. I just hope they don't drag out the old "pre-existing condition? sorry no coverage for that" line. Heck, if they use that then I suppose they could also deny claims for blood pressure medication by saying it is due to apnea which is not covered. :lol: Hopefully my BP issues will be gone soon... gotta stay on that diet!!! Ugh!

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: AHI ~60 / Titrated @ 8 / Operating AutoSet in CPAP mode @ 12

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Zoot
 
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Location: Columbia SC
Gender: Male

Re: Blue Cross/Blue Shield

Postby Zoot on Mon Nov 03, 2008 12:30 pm

I work for BCBS in SC. I meet my deductible(750) and then they pay 80 percent of the rental(250 a month) then after 10 months it converts to ownership

SO in October I paid 714 dollars for the humidifier, masks and first months rent. Next month and december will be 50 then my deductible again in Jan, Feb And Mar so 250 x 3 = 750 and then 50 for apr, may, jun, jul and aug.

714+750+250+100=1814 for a M Series BiPap auto with no data card capabilities and a Humidifiers, that I don't know if it works that well.
Madness take its toll, please have exact change.

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KengEsq
 
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Location: Northeast USA
Gender: Male

Re: Blue Cross/Blue Shield

Postby KengEsq on Mon Nov 03, 2008 2:47 pm

GuyK wrote:First of all -- I'd like to point out that there are several BCBS companies. For example, I am now under an HMO that is part of BCBS-Massachusetts. In the past, I've also been under Anthem BCBS (a New Hampshire employer) and will be moving to Anthem BCBS this next January (change of medical plan from my employer). You most likely will be covered under BCBS of Texas, as a guess, and their website and policies may be completely different than what I have experienced.

My coverage under my BCBS HMO has been great. The only snag in the process is that one has to have a PCP who refers to a sleep specialist. After that, everything has been covered: one sleep lab visit for PSG, one sleep lab visit for titration, followup with somnodoc, referral to DME and R/T. In my case, APAP fully covered (I've seen no bills or copays or anything), masks and supplies (I'm on my original setup, so I haven't tested any of this yet).

I had one small glitch: on the BCBS website, there is a "medical policy" which lists treatment and coverage for OSA. That policy says "APAP coverage only on failure of CPAP". My somnodoc told me he was prescribing APAP, and I mentioned the policy. He said he would let the DME deal with that. When I spoke with the DME, they told me that I was fully covered for APAP. A non-issue.

I also have Mass. BC/BS but my medical providers are at Lahey Clinic. I was told by my Lahey doctors and by my equipment provider (Praxaire) that an APAP is not for treatment but is only used as a diagnostic tool. I know that is not true as an APAP is an accepted "optional" treatment especially if OSA is not being controlled by a CPAP. How do I convince my doctors and my DME to treat me with an APAP?

So, everything has worked out fine for me, and I've only paid $40 out of pocket so far (two $20 copays for somnodoc office visits).

_________________
Mask: Mirage Activa™ Nasal CPAP Mask with Headgear
Additional Comments: ResScan Card Reader - Pressure 8.8 - 14.6 cm H20, med 10.8 - EPR off LEAK med 0.0 AHI 3.2, AH 0.2, Time in apnea med. 0.0, SmartStart ON

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stacia123
 
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Location: Manhattan, Kansas
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Re: Blue Cross/Blue Shield

Postby stacia123 on Tue Nov 04, 2008 2:43 am

I have Empire BCBS and they're okay. The company itself is fine, it's just that the coverage is too ding-dang expensive. Our plan has $3500/year per person out of cost expense, and it can only be reduced down to $2500/year at best, but that triples the premium.

Anyway, as far as the OSA coverage goes, they were great with the sleep tests. Paid it with no fuss. My DME is lazy and hasn't even billed them for the CPAP yet, even though I've had it 3 weeks, but I was told twice that they will pay for it, subject to any out of pocket or deductible of course. We'll see. I'm sure if it all goes to heck I'll be here posting about it ;)
Remstar Pro M w/C-Flex, Integrated Heated Humidifier, Smart Card
Masks: F&P Flexifit 431, small, and Padacheeks

nate fry
 

Re: Blue Cross/Blue Shield

Postby nate fry on Thu Nov 06, 2008 4:18 am

I have blue cross and they have been great. I have been on cpap 6 years and just decided to have the surgeries on the 21. It was all inpatient and they paid 100 percent. good luck
Paul56 wrote:More out of curiosity than anything...

I am currently living in Canada (Ottawa) and expect to be moving with my company to Texas (San Antonio) at some point in the next year.

We have setup with Blue Cross/Blue Shield in Texas for medical benefits.

In your experience how are they to deal with in terms of sleep apnea and getting your equipment?

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AuntieNae
 
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Joined: Mon Sep 22, 2008 5:28 pm
Location: Waukesha, WI
Gender: Female

Re: Blue Cross/Blue Shield

Postby AuntieNae on Wed Nov 12, 2008 10:38 pm

BCBS Anthem - WI
paid 100% of both sleep studies
paid 100% of CPAP machine

but paid $0 for replacement filters.
S8 AutoSet II with H4i Humid, reader + software
M Series Auto w Aflex with HH, reader + software
IntelliPAP AutoAdjust with HH, reader + software
Mirage Liberty Full Face with Nasal Pillows and Head Gear
Pursleep, Pad A Cheeks~ :)
Started 9/12/08

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lovey
 
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Re: Blue Cross/Blue Shield

Postby lovey on Wed Nov 12, 2008 10:55 pm

I have Anthem BC/BS out of Indiana. Generally they have been good with any sleep apnea needs...I pay 30%, and have a $500 deductible. I am on Michigan Medicaid though, so those costs are paid for me. I have had trouble with other services (cardiac rehab) being denied six months after the service for medical necessity. It was basically a coding error on the part of my doctor, but I went through hell to get it paid for. Most BC/BS publish through their "utlization management" guidelines on what they consider medically necessary. I would take a look (it's probably available online) at these guidelines to get a sense of how the specific BCBS company treats your sleep apnea condition. Good luck!
Highest courage is to dare to be yourself in the face of adversity.Choosing right over wrong, ethics over convenience, and truth over popularity. Travel the path of integrity without looking back, for there is never a wrong time to do the right thing.

BeanMeScot
 
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Re: Blue Cross/Blue Shield

Postby BeanMeScot on Thu Nov 13, 2008 11:29 am

I hate trying to deal with insurance. They have NO idea what is going on until they get a claim. We are changing to BCBS Jan 1st. I called yesterday to see if I could find out how much they will charge me and they really have no idea. The woman seemed to think it would be part of my deductible. Preventative stuff is covered at 100%. I would think CPAP would qualify as prevetative. I doubt I will know now unless I submit claims. I will probably just try and get my machine covered under my insurance before I leave this company.

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