Insurance reimbursement

[zoocrewphoto]

I know that the online places do not accept insurance. I'm wondering if I can submit a receipt and get a partial reimbursement. If so, do I need to ask for something specific in the paperwork, or just make a copy of the invoice?

My DME told me a couple weeks ago that the headgear for the Quattro FX does not come in small, even though I saw it on ebay. I emailed Resmed, and they replied with the order number. I forwarded that to my DME, and they told me that they cannot special order it. I checked our host, and they have it for the same price as the ebay seller, so I will support our host. But if I could get some reimbursement from my insurance, that would be awesome too.

I will contact my insurance company as well to ask them. But if I need to ask for something when ordering, I don't want to find out later that I did it wrong.

[BostonGal]

cpap.com will give you a copy of a form, in insurance-ese, that you can submit to your insurance company. I think it's comes in a link in the email they send to you when shipping. This is different than your invoice as the insurance forms have the special medical codes.

Whether or not you get reimbursed by your insurance company is another story. Your insurance probably covers x-many items per month, 3 months, 6 months, etc. Also, you will only get reimbursed at the out of network amount.

That being said...I'm going to try it. I have UHC and they say they only reimburse a mask every 6 months. But I have bought 2 at cpap.com as I have been trying to find my nirvana. I figure at the end of the year (after I get my 6 month mask from the DME) I"ll submit my forms and see what happens. I'd love to get 70% back for what I paid...but i expect I will be denied. It's a shame since it takes time to get your feet under you with this whole cpap thing. It would be nice to have a partial reimbursement.

Good luck

[greenguru]

Everything you need is on the receipt you get. I have 3 paper claims going with Anthem BCBS right now. My out of network is 60% but I have met my deductibles and out of pocket so I should get 100%. You will need to use what ever form you insurance needs. The forms need diagnosis code, procedure code and tax id. These are all all on the stuff you get from our host.

[greatunclebill]

My DME told me a couple weeks ago that the headgear for the Quattro FX does not come in small, even though I saw it on ebay. I emailed Resmed, and they replied with the order number. I forwarded that to my DME, and they told me that they cannot special order it.

all quattro fx masks including fx for her ship from the factory with medium headgear. large and small must be ordered as a separate item. if your dme will not special order it for you, you really should find a new dme for them lying to you.

even though headgear is billed separately, i believe the quattro fx must be bought with the medium headgear. i mean i don't think it is possible to buy the mask without headgear and order the headgear separately. so if the mask came with the headgear and the medium headgear was charged, that was your headgear so insurance isn't going to pay for a second one. that may be why the dme said they couldn't order it, because insurance wasn't going to pay. i hope that made sense to you.

as far as the insurance reimbursment questions, the obvious answer is to speak with your insurance prior to purchase, not after the fact.

[zoocrewphoto]

My DME told me a couple weeks ago that the headgear for the Quattro FX does not come in small, even though I saw it on ebay. I emailed Resmed, and they replied with the order number. I forwarded that to my DME, and they told me that they cannot special order it.

all quattro fx masks including fx for her ship from the factory with medium headgear. large and small must be ordered as a separate item. if your dme will not special order it for you, you really should find a new dme for them lying to you.

even though headgear is billed separately, i believe the quattro fx must be bought with the medium headgear. i mean i don't think it is possible to buy the mask without headgear and order the headgear separately. so if the mask came with the headgear and the medium headgear was charged, that was your headgear so insurance isn't going to pay for a second one. that may be why the dme said they couldn't order it, because insurance wasn't going to pay. i hope that made sense to you.

as far as the insurance reimbursement questions, the obvious answer is to speak with your insurance prior to purchase, not after the fact.

Thanks (and to the other replies as well). I was planning to call the insurance company today, but forgot. So, I will do that on Thursday. I have one other thing to try as well. My mom has her appointment with my sleep doctor on Friday. They have their own DME as well that I Have not used. So, I will ask about it there and see if I can get it that way. If not, I will order via cpap.com. If the reimbursement goes well, then I may do most of my business there. If I can get 85% coverage at their prices, then my 15% will be smaller than at the DME. I think my DME is pretty good compared to many I have read about here. But I am not impressed by this at all. At least my major purchases are done, so it will be mostly smaller items spread out over time. So, paying in advance and waiting for reimbursement won't be as big a deal.

[archangle]

Some people have had insurance claims denied because the mask was bought online.

You may also face a new deductible if the provider is not in-network.

Don't count your claim payment until it's hatched.

[zoocrewphoto]

Some people have had insurance claims denied because the mask was bought online.

You may also face a new deductible if the provider is not in-network.

Don't count your claim payment until it's hatched.

Definitely.

In this case, I have no choice, unless I can get it through the other possible DME. I will talk to them on Friday. Otherwise, I am on my own, or I don't get it. I
did send an email to my insurance provider to see if I can get an answer in writing first. If I don't get a reply, I will call them on Thursday. I also asked how often I can get things since the DME was vague about when I got my machine. Rather than reward them for lying to me, I will see if I can take my business elsewhere.

My current plan is pretty good, and I believe I get the same percentage of coverage regardless of in or out network. I have the best plan, and they try to get us to downgrade every year by offering is a plan with a cheaper premium. But I only pay $9 a week for single coverage, and I work part time. So, it is good. I would like to save up some supplies as I want to have a backup set at all times. And I am concerned about my plan being reduced or cancelled next summer when my contract is up. Last year, they made us jump through hopes to keep our HRA account and low deductible. Those that didn't jump lost their money and doubled their deductible at the same time. This year, we have more hoops to jump through. I will anyway as part of it is the annual physical which I do anyway. But I know they are trying to make us do more, and they are getting more personal about our information.

I will wait until I know reimbursement works before I try buying anything I know I can get at the DME. The prices are outrageous though. They charged me $308 for my hybrid liberty mask PLUS $50 for headgear. The same mask, with headgear is $207 on cpap.com. My 15% at the DME is $53.70. If I bought it at cpap.com AND get reimbursed, my 15% would be $31.05.