Howdy,
Recently, this board has seen many have success purchasing online and then filing for Insurance Reimbursement. From time to time, broad tips for getting this done are given. However, there's no definitive source, no "guide to insurance" for the noobs (or vets who don't want to pay out of pocket!) to reference. Right now people who ask this question are answered "You can probably get paid, good luck". I hope that in the future, we can provide them with a more solid answer.
This is a request for specifics. How did you get paid. How did you verify you were covered before you purchased? What documents did you need to provide?
We're open to support in any form the community will give it. If someone can step up and write up a full document, we'd be very happy with that. However, any bit of advice, experience or know how posted here will be reviewed and most likely added into a document we plan on creating ourselves for this topic.
Thanks,
Johnny
Getting Insurance Reimbursement For Online Purchases
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forumadmin
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Getting Insurance Reimbursement For Online Purchases
Last edited by forumadmin on Wed Jun 01, 2005 12:17 pm, edited 1 time in total.
I called both my insurance provider and my agent and got them involved in the process. When the insurance company first told me that if I went out of network to buy it, that I would have to pay for all of it, I told them if they had enough money in their account to be able to afford paying my hospital 2700 dollars for a machine I could buy online for under 500, then I would just skip the next 3 months premiums. They got a little more cooperative after that. He then sent me a form in the mail for the reimbursement. I have not gotten reimbursed yet so I cannot say there will be no complications, but I will post what happens during the process if it helps.
The main thing when dealing with the insurance companies on these things is to stress you are buying the exact product at lower prices and thereby you are taking an active role in keeping their costs down. That is something they can start to relate to and should accept it. What I was told is that it is unusual for patients to get involved in trying to reduce costs so the companies don't have the infrastructure to deal with it.
The main thing when dealing with the insurance companies on these things is to stress you are buying the exact product at lower prices and thereby you are taking an active role in keeping their costs down. That is something they can start to relate to and should accept it. What I was told is that it is unusual for patients to get involved in trying to reduce costs so the companies don't have the infrastructure to deal with it.
my insurance with my job kicked in last oct 1st. They did state in a letter I had a six month waiting period for previous conditions. Since they were covering prescriptions, I called to see if a machine would be covered.The guy said yes. I said I wanted to buy it online to save us tons of money. Bluecross said no problem. Submit form. So I bought whole package end of january for $2000. Like a dummy I didn't get this in writing. Well, my claim was rejected. Didn't wait required 6 months. So its in appeal. I will take it to the top if necessary. Like I told them; I could have easily waited 2 mos if I was informed. So my warning is to get everything in writing BEFORE you buy out of pocket. What a faceless person tells you on phone may not be right. I will let you know as things progress.
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SnortPumper
Getting the Blues to Pay
I too thought it would be nice to save the insurance company, and myself a lot of money by skipping the medical equipment companies and their 300% markup by purchasing online. After 11 months of aggravation, I finally got an EOB and check out of Blue Shield of CA for less than 1/3 of the total cost. I had to file a grievance petition to get them to even acknowledge my claim. Bottom line: if your time and sanity are worth anything, dont bother filing a claim with the Blues. They are totally incompetent in processing any claim that doesnt come from their usual approved providers. What really frustrates me is that I cant identify a senior person(s) in BC/BS who has responsibility for this mess and the power to fix it.
Well
I hope I don't have the same problems you two have had, but that is a possibility. My insurance agent brought over a claim form today and called BCBS to verify what we were doing and they confirmed it would be accepted, but the check isn't in my hand yet so I am not holding my breath.
In the mean time, even if they do not pay, in the end for something like this i may be ahead in the long run paying out of pocket because having them pay 80 percent of a 2700 dollar machine would probably increase my rates next year anyway, as I am a sole proprietor business and I have a very small group.
One thing is sure, the state of minnesota is having alot of discussions about the increasing cost of healthcare and I know my local representative and Senator enough to feel comfortable taking a day off and driving to the capital to enlighten them on this subject. And from what I know of the two of them, they will be very interested in the subject.
I hope I don't have the same problems you two have had, but that is a possibility. My insurance agent brought over a claim form today and called BCBS to verify what we were doing and they confirmed it would be accepted, but the check isn't in my hand yet so I am not holding my breath.
In the mean time, even if they do not pay, in the end for something like this i may be ahead in the long run paying out of pocket because having them pay 80 percent of a 2700 dollar machine would probably increase my rates next year anyway, as I am a sole proprietor business and I have a very small group.
One thing is sure, the state of minnesota is having alot of discussions about the increasing cost of healthcare and I know my local representative and Senator enough to feel comfortable taking a day off and driving to the capital to enlighten them on this subject. And from what I know of the two of them, they will be very interested in the subject.
Buying CPAP equipment on line
1. Call your insurance. Find out exactly what is covered. Some insurance does not cover equipment. Most insurance does, but the amount and process varies greatly from plan to plan.
2. Ask if you must purchase in network, or if you can purchase from any supplier. Some insurance will only cover purchases made from approved suppliers. Most insurance will cover purchases made from any supplier, but at a reduced rate. Make sure your insurance will allow you to go outside of their network.
3. If your insurance covers equipment, and allows you to purchase from out of network suppliers, GET IT IN WRITING. Ask them to send or fax you a letter or statement outlining their terms for equipment purchases and reimbursements, AND pre-approval of the equipment purchase.
4. Once you have the pre-approval and terms in writing, you can make your purchase. Make sure you have the insurance codes to submit the bill. CPAP.com supplies the insurance codes on their invoices, and the codes have been posted on the board previously. (The post from Mikesus on 4/8/05 titled Insurance Reimbursement has a list of codes.)
5. Submit the bill to the insurance, with a copy of the pre-approval letter. If you have them, include copies of the doctor’s prescription for the equipment and the sleep report showing the diagnosis of OSA and the need for the pap machine.
6. If all else fails, write a letter of complaint to your state’s Attorney General’s office, enclosing copies of all relevant papers, especially those from the insurance company. Many states have divisions specifically devoted to insurance claim problems. If your state has an insurance division, send the letter there. If it doesn’t, send it directly to the Attorney General. Send the insurance company a copy of the letter to the Attorney General’s office. You can also write letters to any local consumer protection agencies or better business bureaus. Be sure to send copies of any letters to the insurance agency. It’s amazing how quickly the insurance companies resolve problems when they know letters have been sent to government agencies. (g)
Debbie
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, Prescription
1. Call your insurance. Find out exactly what is covered. Some insurance does not cover equipment. Most insurance does, but the amount and process varies greatly from plan to plan.
2. Ask if you must purchase in network, or if you can purchase from any supplier. Some insurance will only cover purchases made from approved suppliers. Most insurance will cover purchases made from any supplier, but at a reduced rate. Make sure your insurance will allow you to go outside of their network.
3. If your insurance covers equipment, and allows you to purchase from out of network suppliers, GET IT IN WRITING. Ask them to send or fax you a letter or statement outlining their terms for equipment purchases and reimbursements, AND pre-approval of the equipment purchase.
4. Once you have the pre-approval and terms in writing, you can make your purchase. Make sure you have the insurance codes to submit the bill. CPAP.com supplies the insurance codes on their invoices, and the codes have been posted on the board previously. (The post from Mikesus on 4/8/05 titled Insurance Reimbursement has a list of codes.)
5. Submit the bill to the insurance, with a copy of the pre-approval letter. If you have them, include copies of the doctor’s prescription for the equipment and the sleep report showing the diagnosis of OSA and the need for the pap machine.
6. If all else fails, write a letter of complaint to your state’s Attorney General’s office, enclosing copies of all relevant papers, especially those from the insurance company. Many states have divisions specifically devoted to insurance claim problems. If your state has an insurance division, send the letter there. If it doesn’t, send it directly to the Attorney General. Send the insurance company a copy of the letter to the Attorney General’s office. You can also write letters to any local consumer protection agencies or better business bureaus. Be sure to send copies of any letters to the insurance agency. It’s amazing how quickly the insurance companies resolve problems when they know letters have been sent to government agencies. (g)
Debbie
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, Prescription
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johnnygoodman
- Posts: 784
- Joined: Sun Oct 24, 2004 5:13 pm
- Contact:
1. Communication, communication, communication
2. Document, document, document
3. Patience, patience, patience.
I had a fairly pleasant experience with my insurance reimbursement, but it took a lot of work and patience on my part, calling and speaking nicely with my provider representatives and, like it's been said above, GET EVERYTHING IN WRITING! Also, be patient....it took almost a month to get everything worked out, from sleep study approval by my insurance company to the final purchase of my APAP from cpap.com and reimbursement from insurance company.
Before making my purchase, I pointed out to the insurance folks that it was possible to save over $1,000 by buying online. They liked that, even though, like the posts above, it was a bit startling to them that someone would get involved to this extent.
I had not met my deductible ($2,500/yr) for the year, BUT I had a flex-fund (employee contributions) in my cafeteria-style health insurance plan. Also, my employer contributes $750 into the plan. I got in writing that I would be reimbursed for the full amount of the APAP purchase and that it WOULD count toward my deductible.
Additionally, we agreed before-hand, in writing, that the sleep study (since I hadn't met the deductible) would be paid by me and I would get reimbursed from my flex-fund. The total reimbursement pretty much depleted my flex-fund, but since it was all "in network" or "approved", my deductibles for the year have now been met and I should have no out-of-pocket expenses for medical stuff the rest of this year.
Finally, I was provided with a rented APAP from my local DME for a month. They included a mask and hose with the unit (no software or humidifier though). I was able to return the APAP after I got mine in, but had to keep the mask and hose. Fortunately, the mask and I got along good from the first night AND the DME only charged me about 15% more than I would have paid at cpap.com (and reimbursed by insurance company from the flex-fund). I had to pay one month's outrageous rental fee, again reimbursed from flex-fund.
End result: A completely paid for PB420E, heated humidifier, Ultra Mirage Full Face Mask, 2 hoses, Silverlining software and a rested Kajun!
All in all, I think I had a positive experience.....especially considering some of the stories posted here.
This therapy WORKS!
2. Document, document, document
3. Patience, patience, patience.
I had a fairly pleasant experience with my insurance reimbursement, but it took a lot of work and patience on my part, calling and speaking nicely with my provider representatives and, like it's been said above, GET EVERYTHING IN WRITING! Also, be patient....it took almost a month to get everything worked out, from sleep study approval by my insurance company to the final purchase of my APAP from cpap.com and reimbursement from insurance company.
Before making my purchase, I pointed out to the insurance folks that it was possible to save over $1,000 by buying online. They liked that, even though, like the posts above, it was a bit startling to them that someone would get involved to this extent.
I had not met my deductible ($2,500/yr) for the year, BUT I had a flex-fund (employee contributions) in my cafeteria-style health insurance plan. Also, my employer contributes $750 into the plan. I got in writing that I would be reimbursed for the full amount of the APAP purchase and that it WOULD count toward my deductible.
Additionally, we agreed before-hand, in writing, that the sleep study (since I hadn't met the deductible) would be paid by me and I would get reimbursed from my flex-fund. The total reimbursement pretty much depleted my flex-fund, but since it was all "in network" or "approved", my deductibles for the year have now been met and I should have no out-of-pocket expenses for medical stuff the rest of this year.
Finally, I was provided with a rented APAP from my local DME for a month. They included a mask and hose with the unit (no software or humidifier though). I was able to return the APAP after I got mine in, but had to keep the mask and hose. Fortunately, the mask and I got along good from the first night AND the DME only charged me about 15% more than I would have paid at cpap.com (and reimbursed by insurance company from the flex-fund). I had to pay one month's outrageous rental fee, again reimbursed from flex-fund.
End result: A completely paid for PB420E, heated humidifier, Ultra Mirage Full Face Mask, 2 hoses, Silverlining software and a rested Kajun!
All in all, I think I had a positive experience.....especially considering some of the stories posted here.
This therapy WORKS!
_________________
| Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
| Additional Comments: APAP, 8-14 cm H2O. |
This therapy WORKS!!!
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
TXK did a great job explaining.
His first three points can't be repeated enough.
Comunication: You must ask every question, don't assume anything.
Document: Ask for every answer in writing. Ask for the name of everyone you talk to (and write it down).
Patience: It will take much longer that it seems it should, so don't give up.
His first three points can't be repeated enough.
Comunication: You must ask every question, don't assume anything.
Document: Ask for every answer in writing. Ask for the name of everyone you talk to (and write it down).
Patience: It will take much longer that it seems it should, so don't give up.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!
wading thru the muck of the sleep study/DME/Insurance money pit!
11 posts
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