Anyone have Blue Cross Blue Shield for insurance?

[trainhater]

I have BCBS of Illinois and I realize all plans are different but, in general how often can I get new masks and such? I called them and they couldn't find me an answer.

Thanks in advance!

[jnickellrental]

With blue cross of Ga only once a year and a new machine every five.
Josh

[bsil]

I have the same insurance. My DME rep told me that I am entitled to a new mask every 3 months. My issue, however, is how they are going to pay for the machine. I was expecting 80/20 coverage. But that is not how they calculated it on the EOB. I called the benefits department to inquire, they are looking into it and will call me back. This was last week...still waiting to hear. I can let you know how it works out.

[johnnygoodman]

Greetings,

You should give BillMyInsurance.com a call. They can answer your questions and with them YOU choose the equipment want. Here's a link to the general medicare guidelines, off which each insurance company loosely bases their guidelines:

http://www.billmyinsurance.com/cpap-faq/ALL.html#18

Johnny

[NyNurse33]

I have BCBS through Teamsters, but it gets billed to the local plan. My insurance is very good with everything else. 100% dental, medical, no copayments, etc. I was very surprised to see they were not with DME. 80/20. They told me usually no insurance is good with DME. They couldn't tell me how often I could get a mask either, but when I checked with my DME, they said as long as I got a script to do a refit, it would cover it. We'll see when I get the bill

[tmaiberger]

I have BCBS federal and I can get a new mask every three months (which includes headgear). I get replacement cushions for the masks monthly (2 per month) and filters monthly as well (the white pollen one, not the black one for my machine, which I think I get every six months), and I think a hose every month, but I do not see why a hose would not last much longer.

Not sure what the percentage is I have to cover, I hit my maximums early this year with the sleep study (once that occurred I only had to pay 10%), but expect to take a hit early next year when all that resets. Hopefully, my guess on the amount of the FSA to use next year is accurate.

[chdurie2]

johnny:

Billmyinsurance.com has not been working with BCBS. Has that changed recently?


trainhater:

I have BCBS New Jersey, which has no set policy on time periods for mask replacement. My sleep center said to regard that as one mask every three months, I'm guessing because that is the schedule for many insurance companies. However, the customer service people said it could be more often. But I have not tested this.

Caroline

[DreamStalker]

I have BCBS Texas and I was told it was 6 months for mask and 3 years for machine. I guess it depends what kind of deal the employer strikes up with BCBS?

- roberto

[KimberlyinMN]

I have BCBS of MN. I have a $300 medical device deductible and then they pay 80-90%. I'm not sure how often I can get a machine. I can get a full mask every six months and a nasal mask every three months.

Kimberly

[chdurie2]

kimberly:

your policy hurts for someone who can only wear a full-face mask. wonder if they have a provision for that inequity, although it sounds as if the policy is writtten only for people who use a full-face mask as a backup for colds and all. wonder what they would do for someone who has no need for a nasal mask. i guess you're lucky that's not you.

caroline

[KimberlyinMN]

kimberly:

your policy hurts for someone who can only wear a full-face mask. wonder if they have a provision for that inequity, although it sounds as if the policy is writtten only for people who use a full-face mask as a backup for colds and all. wonder what they would do for someone who has no need for a nasal mask. i guess you're lucky that's not you.

caroline

It doesn't make any sense to me why there would even be a difference in the time spans between getting a mask. I mean, a mask is a mask, right? I didn't find out about the nasal mask replacement plan until I went in to complain about how much they were charging for everything. (I brought in a spreadsheet with the breakdown of everything.) They gave me the ol' song and dance that items purchased online might not be new, etc. That the extra amount I'm paying is going towards their service they provide, etc. (MMmmm...hmmmm..)

Kimberly

[kurtchan]

Empire Blue Cross/Blue Shield of New York covers a new mask every 6 months and a new machine every 5 years.

[chdurie2]

Kimberly:

That's what I mean. Your policy is geared towards nasal mask users, which most people are. Lucky I don't live in Minnesota, or I'd be having a big fight with BCBS-- no reason why I as a full-time full-face mask user would only get two usable masks whereas a nasal mask user gets six that they presumably can use.

Guess I should be grateful for some things.

Caroline

[Offerocker]

I have BCBS federal and I can get a new mask every three months (which includes headgear). I get replacement cushions for the masks monthly (2 per month) and filters monthly as well ....

Gee, so do I, but I think it is for another Federal Government than the one you have!!!!!!!!!! I "get" a new mask every six months, and premiums monthly.
Purchased ALL equip shown below from CPAP.COM.
Going to try out the Activa mask before year's end.

[Bookbear]

EVERY insurance plan is different (BC/BS of California has at least 7 different plans that employers can choose from, and within each of those are 'custom' benefit levels that the employer can elect to offer). My BC/BS of Cal HMO plan allows for a new mask every 6 months, a new hose once a year, and a new machine every 5 years. Like you, I had a great deal of difficulty getting an accurate answer from the customer service people at BC/BS... Three calls yielded three different answers. That's how I found out about the multitude of plans and benefit levels even within the same insurance company. I would cross check between your employer and the insurance company, and make multiple calls. Try to get it in writing.

Good luck!