AETNA & Cpap.com reimbursement experiences?

[lebowski8]

So far, my therapy is going really well, 10 days in.
I feel great!

Anyhow, now to pay for it

Does anyone have any insight into getting reimbursement from AETNA Choice POS II High Deductible plan. ($2000) *and* purchasing equipment at CPAP.com ? ?

I skipped my doctor's recommended DME provider, as their prices were going to end up being about $1100 for a 12 month-ish rent-to-own plan. The paperwork seemed ridiculously complicated -- almost $600 for a "down payment" and then a monthly rental fee. Plus the DME sales person was obtuse and wouldn't answer my direct questions.

So, anxious to get my therapy going, I paid out of pocket. I shopped it online, and got the equipment for $710 at CPAP.com ... since i'm essentially out of pocket, i think i'm saving some money.

I folowed CPAP.com's instructions-- I sent Aetna a one page letter instructing to pay me, and included copies of the
* Aetna Medical Benefits Request
* Certificate of Medical Necessity / Prescription (my doctor)
* NUCC Form (pre-completed by CPAP.com, adding additional info per instructions)
* Invoice of Goods Provided (CPAP.com)

This is adequate, isn't it? What's your experience with reimbursement ?
I hate paperwork

I appreciate your comments.

[johnnygoodman]

Howdy,

One word of warning - the pre-populated insurance form CPAP.com gives is a sample/template only. Insurance companies have been known to reject claims because the claim form wasn't red (because the customer just printed our out CPAP.com's pre-populated and sent it in). Yes it is nuts, but they have the power and the incentive to pay slow.

I don't carry Aetna, so I can't be much help on that front, but I wanted to point out the potential roadblock as you're obviously on your game and have invested the time to get paid.

Good luck!

Johnny

[lebowski8]

Howdy,

One word of warning - the pre-populated insurance form CPAP.com gives is a sample/template only. Insurance companies have been known to reject claims because the claim form wasn't red (because the customer just printed our out CPAP.com's pre-populated and sent it in). Yes it is nuts, but they have the power and the incentive to pay slow.

I don't carry Aetna, so I can't be much help on that front, but I wanted to point out the potential roadblock as you're obviously on your game and have invested the time to get paid.

Good luck!

Johnny

Thanks for the warning. Yes, I understand that it's a template. However, I also filled out AETNA's claim form as well.

[DNAClone]

I have Aetna PPO and used a DME recommended by my sleep lab for Aetna patients in the NY metro area. So far, I have received excellent service. I requested in advance the S8 Autoset II by Resmed and the day before it was to be delivered they told me that it would take several additional days to obtain this device. However, they had a an M Series Auto CPAP with A FLex & Heated Humidification. I have had a bit difficulty with LTG Swift nasal pillow after 2 nights so they are sending me a chinstrap and if that doesn't work a Full Face Quattro Mask.

Aetna has paid for 100% and I haven't even had a co-payment expense.
If your DME benefits are subject to your high deductible, it certainly makes sense to do it on your own. If you paln to use your deductible this year, I would have strongly advised going through a "recommended" in- network DME provider. Out of network is more time consuming and has more unknowns but in my experience out of network bills are usually reimbursed at custom and reasonable fees. It just takes 1-2 months to be reimbursed. I would follow up with Aetna customer service to expedite the process.

[lebowski8]

UPDATE:
Since our deductible hasn't been reached for 2009, I suppose reimbursement isn't the right word-- i need my deductible credited.
anyway, to follow-up
I got full credit for the mask, humidifier, and filters purchased from cpap.com
However, I only got a $65 credit for the M Series Pro C-Flex CPAP Machine (out of $459).

What's up with that?!? Seems weird that they'd credit filters for a CPAP but not the CPAP itself!

I sent an email inquiry asking why i hadn't gotten my deductible fully credited.

Anyone have any suggestions on how I might pursue it to get the full credit??

[raylo]

I'm wondering if they are crediting you only what they would have credited toward the first month rental. If so, it would seem appropriate that they at least credit that to you for the rental period. I would be interested to hear what they say. Good luck and keep us posted.

[bjdare]

I also have Aetna (with a $1,000 deductible) and they credited my deductible with $63.45 for the monthly rental of the machine.
I, too, am guessing that's what they did with you instead of reimbursing you for the purchase amount.

I'll be interested in hearing what you find out from them. Good luck!

[lebowski8]

A-ha!
Well, I guess I'm a noob and I don't know how this stuff works!

Well, maybe you guys are right. I'll let you know in a month or so. If thats the way they're going to do it, i'm a patient guy.

I'll let you know.

Thanks!!!

[yorkiemum01]

I too, have Aetna, but must tell you, its very plan specific. Mine has a $3k deductible, and all DME charges
are applicable to deductible, so long term, I found purchasing outright out of pocket to be my best bet.
(only after I racked up $1800 in out of pocket 'rental fee's). I was fortunate enough to find my equiptment
here online through another cpap user, but have purchased with supplies with cpap.com and keep my RX on file
with them as well.

[lebowski8]

UPDATE:
Success!
A day after following up AETNA earlier this week, I got a response that my claim would be re-analyzed.
It was, and now I have received a 100% credit.

So, the answer (in my case) is that AETNA can in fact credit 100% of CPAP.com purchases.

[Blue Waters]

Hi all,

I am about to go through the same procedure -- I have Aetna PPO with $200 deductible and I would like to get my equipment from cpap.com. I looked into local DME's and they seemed to be VERY reluctant to quote me a price. Finally, today I had an appointment with a DME and the price they quoted me for Resmed S9+hose+mask was simply outrageous!

Has anyone had experiences with Aetna reimbursing for cpap.com purchases in recent months?

Thanks.

[BoeingGeo]

How about AETNA Open Access HMO?

[chunkyfrog]

BCBSNE sat on my claim for cpap.com for FOUR MONTHS.
It took numerous calls to get them back on task.
The statement says my OUT OF NETWORK deductible was credited 26 bucks and change.
At this rate it's unlikely I will meet my in-network deductible at all this year.
Guess what company has eliminated themselves from Medigap consideration?