Blue Cross-Blue Shield and Cpap

bsparris wrote: ↑

Tue Apr 03, 2018 9:29 am

I am in Alabama with Blue Cross Blue Shield (Peehip) and have had my CPAP for years. I do not remember having to pay co-pays up front until now. (Perhaps I did and just put it on credit cards and that is one reason I am in such incredible debt now and am finding I don't even have enough money to buy groceries as I am trying to dig my way out of debt.) So now I needed new supplies last fall and had to pay nearly $200 out of pocket as I was told I hadn't met my co-pay. Then my machine quit and I was given a loaner, told that in April my insurance would cover it. So now, one day before my appointment to return the loaned CPAP and pick up my new one, I am told I have to pay nearly $500 for the new machine because I have not met my deductible. Needless to say, I threw a hissy-fit on them on the phone, though doing such is very unlike me normally. They talked it over and said they would go ahead and just bill the insurance. Ok, this buys me some time, but doesn't it also mean once it goes through the insurance, I will be sent a bill for that $500? I still will not be able to pay it. It is going to be a couple years before I am out of debt enough to have that kind of money to pay this kind of bill. When I go to return my loaner tomorrow, should I just say no and quit my CPAP? I know that I could not sleep without it, as I tried when it was broken and I was miserable. And couldn't I also die in my sleep?

First, I'm surprised that you don't realize that your benefits can change annually. Before you sign up for stuff, you should always check with your insurer first. Chances are,yes, you may very well be billed $500 for that machine in future. Make sure that you have it in writing, by the manager, not the PT, that they are accepting what the insurance will pay IN TOTAL. Both of you should sign it and you take an original with you. Verbal contracts aren't worth the paper they are written on.

bsparris wrote: ↑

Tue Apr 03, 2018 9:29 am

They talked it over and said they would go ahead and just bill the insurance.

It sounds like you are talking to the DME about your insurance benefits. This is a mistake. You should talk to a customer service rep at your insurance company. They have access to your policy and know what they will pay, what the DME will get reimbursed and what, if anything, you will have to pay. You should be using an in-network DME. The insurance company will have a contract with them. Employees at the DME often don't understand the contract. Let the insurance company rep be your advocate.

Good luck!

bsparris wrote: ↑

Tue Apr 03, 2018 9:29 am

I can see I am not welcome here. And you for one would probably like me to ditch my CPAP and die at 62--when I only want to live to 64 so that I can get my debts paid off and get my funeral expenses pre-paid and arrangements made. I guess I am not welcome here, so this old lady is going to pack up and leave and won't be coming back, thank you!!!

Maybe I best just go ahead and ditch it, thank you Chunky, you helped me make my decision to die young!!!

This is the internet, ya know?

I apologize for my lack of tact.
You can find better-priced machines online, Secondwindpap.com, or cpap.com.
Even Craigslist.
You do not need to be at the mercy of your insurance.
There are also charities that will help you with equipment.

Large companies like BCBS have multiple plans, so it's impossible for anyone without information to know what YOUR plan is going to cover. In the US world of "medical consumerism", it's up to YOU to know what your plan will and will not cover and how much you have to pay out of pocket.

It's NOT easy to find out, and it drives me nuts when people who talk out of their behinds say that people should "shop around" for the best costs. Providers deliberately obscure costs and very little is standardized.

But here's a secret. You have a contract with BCBS, even if you never saw it and certainly never signed it. It's called the "Evidence of Coverage" and unless you specifically ask for it (every year!) you have never seen it or know what's in it. But you can request it. Most state laws require you to request it in writing, which sets the clock on a time limit for the insurer to provide it--usually 7 -10 days depending on state law. The EOC might be online if you ask, but rarely. Otherwise they will mail it out to you. That EOC booklet is everything. If it says "we cover X" they MUST and if it says "we don't cover Y" they won't. It will outline the deductible and how it's calculated, and your co-payments for each good or service. It should also tell you the maximum you have to pay out of pocket. Sometimes it's a bit obscure. It might say "we cover 80% of reasonable and customary charges for a CPAP machine." You don't necessarily know what "reasonable and customary is" and it can vary if the insurer has a contract with the provider. So sometimes you have to wait for the insurer to issue the "Explanation of Benefits" because the DME may charge $3000 for a CPAP machine, but the insurer thinks the "usual and customary charge" is only $1000 and they will pay $800 (80% of $1000) so you only owe $200. But you can ask.

Remember when calculating the cost of the machine to consider whether your company requires you to "Rent to own" (Usually called a capped rental). This will be explained in the EOB. In those cases, you usually haven't rented it long enough to own it before the new year rolls around with a new deductible, in which it's almost always a better deal to buy your machine yourself from a place like our hosts or second hand.

Bearcat42 wrote: ↑

Sun Apr 05, 2009 8:11 pm

Can anyone tell me how well Blue Cross-Blue Shield insurance pays on Cpap equipment? Mine is out of Texas and I was just wondering if someone else out there with the same insurance has used it for their Cpap needs. Thanks

Totally depends on what your plan is.

I paid zero out of pocket for my home and clinic studies and about 1/4 of the cost of my machine (BCBS Community Blues PPO)

Now I'm on a high deductible plan and would have been out of pocket every thing until my 12k dollar deductible is met (BCBS HMO).

J-