|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|
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).
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?
Users browsing this forum: Rugger and 13 guests