letter of medical necessity for cpap (or apap rather?)

paradise · Post by **paradise** » Mon Oct 02, 2006 10:23 pm

Any one have a format for an LMA for APAP. I want to bring it to my next appointment with a new doctor as old one has moved away. I have a copy of my sleep study and intend to purchase a machine from cpap.com and I just want to move things along (by having a nicely formatted letter for the doc to sign) in regard to getting reimbursed from my Blue Shield PPO plan. If I get the machine straight from a provider that will bill Blueshield they charge more than my policy allows for first dollar (annual allotment) benefits- $1400 vs $630 ish.

Any advise on buying- then getting reimbursed?

I want the auto titrating model- will that be an issue?

My current cpap maxes out at 15- my prescribed pressure and I think that doesn't cut it any more.

Should I get a humidifier? I have never used one- been using cpap for several years though. I don't know what normal is, but I do feel "dry" and have difficulty just breathing through my nose sometimes in general.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, auto, APAP

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): humidifier, cpap.com, CPAP, auto, APAP

snoregirl · Post by **snoregirl** » Tue Oct 03, 2006 5:47 am

I can't tell you about reimbursement for a cash purchase as my insurance wouldn't go for it.

And, I don't quite understand the statement about charging more for the first $ than you policy will allow.

What I can tell you is if you are going to pay more out of pocket by going through a local DME than on line, and you want to buy cash from CPAP.com, you don't need the letter of medical necessity, or the sleep study, or a scirpt for anything but CPAP. CPAP script is good for APAP.

If you intend to try to get reimbursed by your insurance, then the other items may well be necessary.

And yes I personally think a heated humidifier would be a good idea. It is cheaper when you buy both the machine and humidifier at once from CPAP.com as a bundle.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, DME, APAP

munsterlander · Post by **munsterlander** » Tue Oct 03, 2006 3:17 pm

I am relatively new to this forum and became a member when I tried to purchase on-line. I would highly recommend billmyinsurance.com. They were very helpful and worked directly with my insurance company and my doctor to get everything that was needed. The only thing I had to provide was my original sleep study report which I scanned and sent to them as a n Adobe file. I was able to get the equipment I wanted and they came to an agreement on the costs with my insurance company (BC/BS). A personal follow-up email from them to make sure everything was going well was appreciated. I got much better service from them than my previous DME.

It never hurts to ask!!!!!!

Wulfman · Post by **Wulfman** » Tue Oct 03, 2006 4:05 pm

As Snoregirl said, all you need to purchase the equipment from CPAP.COM is your prescription. You don't need a letter of necessity. If you don't have your prescription, get it from your doctor.....or have your new doctor write another one for you. You NEED to have it.

I question that your machine has "maxed out" at 15, as all of the CPAPs I've heard of go to 20 cm. But, I applaud you for wanting to get a newer one.

I'm also a member of a PPO (self-insured) and they reimbursed me at the "in-network" rate (80%). I just submitted an invoice (from me) to them with the exact same information (descriptions/numbers/prices) as was on the invoice from CPAP.COM......no problems.

Best wishes,

Den