Cigna Coverage for CPAP.com

[BrooklynCPAPer]

Hi all -

I'm wondering if anyone has had success with submitting out of network claims to Cigna for CPAP.com purchases? I seem to be going through a loop trying to get them to process the claim I submitted. It was only for a new mask and some miscellaneous supplies so if it doesn't end up getting paid, it won't bankrupt me but just curious if others have had luck and if so, did you submit anything beyond the claim form and receipts?

[chunkyfrog]

First, you call Cigna and determine if cpap.com is in- or out of network,
And if your coverage is for out of network, which it probably is, what is the deductible and your copay.
In and out of network is often calculated completely separate, so you start from scratch.
In my case, BCBS LOST my claim, which seems to be another sneaky trick they pull.

[Joshkins]

I believe you have to submit your claims through Carecentrix. They are the company that Cigna lets run their CPAP coverage

[chunkyfrog]

Good catch! Glad I don't have to deal with that mess!

[Bill44133]

I believe you have to submit your claims through Carecentrix. They are the company that Cigna lets run their CPAP coverage

That is correct you have to submit everything to Carecentrix. I have gotten credit toward my deductible using
cpap.com purchases.

I wish you well...

[Redonthehead]

i have submitted a claim for a P10 mask directly to Cigna without going through Carecentrix. I meticulously filled out the proper forms including the one CPAP.com will assist with (has their coding etc). It was covered, although in the out-of-network side.

[Sheriff Buford]

I have Cigna PPO. It is an HMO. I have dealt with Carecentrex as well. I asked about using cpap.com, and was told no. Maybe the PPO thing. I am stuck with Crapria. What a nightmare!

Sheriff

[BrooklynCPAPer]

Thanks for all of the replies. CPAP.com is definitely out of network so I knew it would be at that rate if covered at all. Care Centrix told me the claim can't go through them because it's out of network. As luck would have it, Cigna posted their second review of the claim online today and it looks like this round's notes are that the claim is still denied and code 0084 - YOUR PLAN PROVIDES BENEFITS ONLY FOR COVERED EXPENSES FOR TREATMENT OR DIAGNOSIS OF AN INJURY OR ILLNESS. I put the smiley face since if their claims team bothered to look back a couple of pages, they'd see they're already paying for a CPAP machine.

I'll probably give them a call on Friday and try one more time. I hate to have to order masks and supplies through my DME because they make it way harder than it needs to be but I also can't pay out of pocket every time I need a new mask or other supplies.

[chunkyfrog]

I assume you live in Brooklyn.
Is Crapria the only DME in network?
THERE? In Brooklyn!
Egad! That would certainly put that insurance company in the file 13 list!

[BrooklynCPAPer]

I assume you live in Brooklyn.
Is Crapria the only DME in network?
THERE? In Brooklyn!
Egad! That would certainly put that insurance company in the file 13 list!

I indeed live in Brooklyn. My DME is Medstar and in-network. I think Sheriff had to use Crapria but they're all awful IMHO. Care Centrix said they'd help me find a different DME next time I need a mask that's also in network. It's a shame DME's make life so difficult. I'm 35 and in good health overall so I'm able to handle this stuff on my own (with a little help from this site, of course) but I can't imagine what it's like for someone who has a serious illness and trying to get home medical equipment.

Thanks all for your help. Sleep well!

[chunkyfrog]

If I ever get to the point where I consider changing Part B supplements,
I plan to get a list from my DME of which plans they are in network for.
I want to keep them. They are sweethearts.

[Wulfman...]

Thanks for all of the replies. CPAP.com is definitely out of network so I knew it would be at that rate if covered at all. Care Centrix told me the claim can't go through them because it's out of network. As luck would have it, Cigna posted their second review of the claim online today and it looks like this round's notes are that the claim is still denied and code 0084 - YOUR PLAN PROVIDES BENEFITS ONLY FOR COVERED EXPENSES FOR TREATMENT OR DIAGNOSIS OF AN INJURY OR ILLNESS. I put the smiley face since if their claims team bothered to look back a couple of pages, they'd see they're already paying for a CPAP machine.

I'll probably give them a call on Friday and try one more time. I hate to have to order masks and supplies through my DME because they make it way harder than it needs to be but I also can't pay out of pocket every time I need a new mask or other supplies.

The question(s) you need to ask is whether YOU are considered "in-network" and whether they would reimburse YOU if you make out-of-pocket purchases.
When I purchased my initial equipment, I discussed it with my provider BEFORE I purchased anything (even though I was prepared to buy all of my equipment out-of-pocket rather than to have to deal with a local DME). They told me that I would be considered 'in-network" and they would reimburse me at the 80% rate. After I purchased my equipment from CPAP.COM, I used the invoice from them to prepare an invoice to bill my insurance provider.......using myself as the party doing the billing and the insurance provider as the party being billed. Everything worked out fine.


Den

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