bcbs, dme

gster · Post by **gster** » Sun Feb 11, 2007 9:52 am

bcbs will not allow me to send in any bills for reimbursement for online purchases of cpap maintenace items . i have a dme of $1500 per year. i was told these purchases are considered out-of-network. i see the contract allowance on my bcbs statement and see the online prices; most online prices can be lower. now, if i can lower the cost of my cpap maintenace items per year i will never go over the ceiling of $1500. seems bcbs is willing to throw away good money. or are they not willing to change.

first post !!!!!!!!!!

Wulfman · Post by **Wulfman** » Sun Feb 11, 2007 11:10 am

Ask them if YOU are considered "in-network".....then ask if they will reimburse you at the "in-network" rate if the invoice is from YOU. The way it needs to be done is to submit a bill from yourself to your insurance provider for exactly the amounts (and with the appropriate billing codes) from the invoice you received from the online supplier. You will probably also need to send them a copy of the invoice you received from the online supplier as proof of your purchase.
The invoice has to be FROM YOU (as the billing party) and to the insurance provider as the party being billed.

If you just try to send them the bills that you've paid to an online supplier, they will, of course, (as you found out) consider them as out-of-network.

Best wishes,

Den

UncleLeo · Post by **UncleLeo** » Sun Feb 11, 2007 11:14 am

I have BCBS, and I ended up getting frustrated and buying out-of-pocket and out-of-network. Bottom line, I have a $1000 deductible and 50% co-pay after that for DME and at my local DME supplier it was going to cost me $1500 to get started... after deductables and co-pays and everything. I bought online, got a better machine, and paid $900.

I'm hoping that I can submit my invoice and at least get something credited toward my deductible, but I'm not expecting much, if anything.

UncleLeo · Post by **UncleLeo** » Sun Feb 11, 2007 11:16 am

Wulfman wrote:Ask them if YOU are considered "in-network".....then ask if they will reimburse you at the "in-network" rate if the invoice is from YOU. The way it needs to be done is to submit a bill from yourself to your insurance provider for exactly the amounts (and with the appropriate billing codes) from the invoice you received from the online supplier. You will probably also need to send them a copy of the invoice you received from the online supplier as proof of your purchase.
The invoice has to be FROM YOU (as the billing party) and to the insurance provider as the party being billed.

If you just try to send them the bills that you've paid to an online supplier, they will, of course, (as you found out) consider them as out-of-network.

Ooh. I like that idea. Does that really work?

Wulfman · Post by **Wulfman** » Sun Feb 11, 2007 11:24 am

UncleLeo wrote:
Wulfman wrote:Ask them if YOU are considered "in-network".....then ask if they will reimburse you at the "in-network" rate if the invoice is from YOU. The way it needs to be done is to submit a bill from yourself to your insurance provider for exactly the amounts (and with the appropriate billing codes) from the invoice you received from the online supplier. You will probably also need to send them a copy of the invoice you received from the online supplier as proof of your purchase.
The invoice has to be FROM YOU (as the billing party) and to the insurance provider as the party being billed.

If you just try to send them the bills that you've paid to an online supplier, they will, of course, (as you found out) consider them as out-of-network.
Ooh. I like that idea. Does that really work?

It did for me and quite a few other people. However, I DON'T have BCBS, but some of the others that DO, said it worked for them.

One of the things that helps is that you should do some communications with your insurance provider before you attempt this. Be nice, ask them questions and be sure to get the point across that you WANT to save everybody some money.

Den

dataq1 · Post by **dataq1** » Sun Feb 11, 2007 2:34 pm

Hope that it does work for you!
I tried pleading this case to Highmark BC/BS (Western Pa) and they would have none of it. Pleaded the same case to my employer (mine is a self-insured policy, that is, my employer is actually paying, BCBS just manages the health plan), and they said they were bound by the BCBS management.

Anyway I was unsuccessful in my attempt to save money all around. I'd be interested in how you make out in this. Perhaps you can give me some pointers that I may have overlooked.

Let me know how it works out. It does seem very strange that we consumers should have to fight to save our employers and their health plans money.