Submitting CPAP.com purchases to your Insurance Company

[Kenwood]

What has been your experience on submitting the CPAP.com purchases using their "pre-printed Insurance form" theory provide you to your health Insurance company for reimbursement? I have Aetna.

[chunkyfrog]

I did it once with BCBSNE. They misplaced it for about 5 months,
and finally processed it as part of my deductible for out of network--separate from in-network.
Needless to say, those morons never even got considered for my Medicare supplements.

[HerbM]

Before ObamaCare caused Symmetra to cancel our policy of 20 years we submitted ANY valid medical expense and they just paid, no questions asked.

Even my Rolfer was accepted the one time I submitted it -- loved that insurance.

It will vary, perhaps wildly, by carrier. (One time, Symmetra just sent us a sizable check and said they had checked our account for the past year and realized they owed us money -- unasked, and unexpected.)

I have Aetna now and so far they are pretty good but we haven't submitted any direct expenses yet.

[Kenwood]

Should also mention. I need to meet my annual deductible ($500) before my insurance company pays 50% on DME. So I'm really just looking to get the amount credited towards meeting my deductible.

[Pugsy]

Send it in and make them at least do the work to process it. If you don't...you know you won't get anything applied to deductible.
It's going to depend on how they view cpap.com as a provider and that varies with insurance companies and even with different plans within one company.

[chunkyfrog]

I just ignored my insurance the last couple of years where it came to cpap supplies.
I used my FLEX to find my best mask(s) and then used trades and various sources to replace consumables.
Once Medicare kicked in, I have gone to using Apria [as long as they don't screw up]

[zoocrewphoto]

I just ordered some mask cushions on ebay. I got 2 cushions for my quattro fx for only $55. I tried to see if I could use an online retailer who would submit the bill to insurance (and thus pay with my HRA account), but they would not.

I have insurance, but my deductible went from $250 to $1000. Without an emergency, I won't reach that in a year. And I really don't want an emergency or having to pay that deductible. My income went down last year, and I have some new expenses this year as well. I can't afford to add a bunch of new bills. I do have an HRA account with about $400 in it, but I can't use it online. If I use it with a local DME, I will get charged the full retail price. I don't want to waste my HRA on full retail prices. It would go too fast. Once my HRA is gone, I move on to the deductible. So, I decided to use ebay for mask supplies, save the HRA for doctor appointments, and if I avoid any emergencies or special tests, I can get by without having to pay that deductible. Otherwise, I have to use my HRA and pay the $1000 before I get to my 85% DME coverage.

[Wulfman...]

What has been your experience on submitting the CPAP(dot)com purchases using their "pre-printed Insurance form" theory provide you to your health Insurance company for reimbursement? I have Aetna.

Back in 2005, I bought all of my initial equipment out-of-pocket from CPAP(dot)COM and then typed up an invoice from me (as the billing party) to my insurance provider (as the party being billed). They paid 80% of the allowable DME equipment (I also had software in the order and they wouldn't pay for it because there was no insurance code for that).

I should note that my employer was self-insured and they contracted with an insurance entity to process their billing as a PPO. I also contacted them beforehand to ask them if they would reimburse me and they indicated that they would.

That was quite some time before CPAP(dot)COM came up with their form, but the process DID work for me.
CPAP(dot)COM's invoice had all the insurance billing codes on it, so I basically used their invoice format and changed the information to reflect the different billing/billed parties.
That was the only time I did that. From then on, I purchased all of my machines and supplies out-of-pocket. Primarily because I never met another deductible until 2011........and by that time, I was pretty much stocked up on supplies.


Den

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[chunkyfrog]

My first year, insurance covered 2 sleep studies and my initial equipment,
so all my masks and pillows/cushions were covered except the co-pay.
The following year, I finally met my in-network deductible mid-year
(out of network would have been double.)

[Wulfman...]

CF reminded me of something else. My insurance provider considered ME to be in-network, so, that's why they reimbursed me the 80%. Otherwise, it would have been 60% for out-of-network.
I was prepared to buy the whole works out-of-pocket, because I didn't want to have to deal with any of the local brick & mortar DME shops, so I'm glad I did it the way I did.


Den

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[StuUnderPressure]

I could NOT do that with my previous BC/BS PPO because one of the stipulations of a DME being a "approved Provider" is that the Provider MUST file the claims.

Works the same way now with my Medicare coverage.

[Redonthehead]

I just recently called Cigna to find out if I could buy the DME myself and submit the claim to them. They were real bitchy and rattled off a bunch of information I would have to get from the seller to do this - like federal tax ID blah blah blah.

[Boomer]

Hello all. It has been a while but I'm back...on CPAP.

I also have Aetna. Back several years when I was first diagnosed, I purchased all my gear from here and submitted the claim to Aetna. They paid 80% no questions asked. Even the software (Encore).

I just purchased a new setup from here a couple weeks ago. I submitted the claim and have yet to hear or see anything.

Best of luck but I would expect just 60% this time as they now see cpap(dot)com as "out of network".

Boomer

[Wulfman...]

Hello all. It has been a while but I'm back...on CPAP.

Boomer

Hey Boomer! Good to see you're still "topside".

Hope everything is well with you.

Best wishes.


Den

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[star444]

I just recently called Cigna to find out if I could buy the DME myself and submit the claim to them. They were real bitchy and rattled off a bunch of information I would have to get from the seller to do this - like federal tax ID blah blah blah.

If you purchase from CPAP.com you can log in to your account and print an insurance claim form that contains information about the equipment you purchased, and, has their Federal Tax ID and other pertinent information pre-printed on the claim form.