Online CPAP vendors will they provide predetermination

[Cpapian]

I am still fairly new to xPAP- just 4 months in. So this is basically a Newby type of question.

For my situation, masks are reimbursed by supplementary health insurance. I asked them if I found a better price online, could I purchase masks online. They said only if I had a predetermination from them.

My DME charges too much for a mask and that bugs me.

Does anybody know if any online vendors will provide a predetermination first?

I am in Canada, so no medicare.

[greatunclebill]

I'm not sure what you're calling a predetermination. Whatever it is i don't think the vendor does it. the big prices from the dme are not normally what is approved and paid. find out from the insurance what your actual cost will be thru the dme.

[nanwilson]

I live in Alberta and buy masks and supplies on line from all over all the time with NO PROBLEMS. Also, no script required ...

You are being fed a big fat "untruth".

[Pugsy]

I would think that you need to ask your insurance company what constitutes "predetermination" and that should tell you what all is involved.
Sounds like it might be similar to what we have in the US when insurance requires a pre approval or pre authorization be done before a procedure is done so that it will be a covered expense.

[Arlene1963]

I live in Alberta and buy masks and supplies on line from all over all the time with NO PROBLEMS. Also, no script required ...

You are being fed a big fat "untruth".

Yes, I've had no problems with my insurance claims. Didn't need a prescription with the online co (based in Ontario) either, although my insurance company has the original prescription on file.

I spoke to my insurance co before buying online, and they told me as long as the receipt has my full name and address on it along with particulars relating to the purchase that is okay. I'm in Ontario.

I hate paying almost double from the local VitalAire outlet locally. Online is the way to go.

[Cpapian]

Yea - a predetermination is like an estimate just in writing, and the insurance company gets to set its own rules. So if I want reimbursement I have to get an estimate from the supplier first. What I am trying to figure out is if any online suppliers are willing to go the extra step.

Between our two insurance coverages, I should get 100% reimbursement on masks. So am trying to figure out how to do this with their difficult requirement.

Doesn't matter that I am trying to save them money.

Arlene can you pm me with the name of your supplier?

[Arlene1963]

Arlene can you pm me with the name of your supplier?

No problem! Check your PM.

[Soothest Sleep]

The predetermination is issued by the insurance company, based on the estimate of equipment costs. The insurance company will then tell you whether, and how much, they will reimburse you for the expenses. Your insurance policy may have limits set on the number of items, or the total dollar value, or the yearly dollar value, or the dollar threshold that has to be met in order for other benefits to be available (% of reimbursement, e.g.) etc., and the predetermination notice may provide that information so you can better budget for your equipment.

You just have to inform the insurance co. of the cost of the equipment you are planning to get; they probably have a form for that purpose. When I have expensive dental work to be done, and when I was getting my APAP, the various office staff did the paperwork because they receive payment directly from the insurance company. Most medical/dental/pharma suppliers in my province are able to direct-bill insurance companies; the only claims I have placed personally have been for physiotherapy sessions (on the required form and with receipts to support the claim). If I was buying xpap supplies/consumables from an online company, I would just submit the claim with receipts and let it be processed in the usual way. It's the big ticket items that really need the predetermination, so you don't get a surprise after the fact of purchase. If the insurance company isn't going to cover part or all of the expense, you'd want to know that before you pay for equipment.

Check your insurance company's website; there may be information there on the specifics of their process, and you may be able to log in to your account to see details of your personal coverage.

Jean

[Arlene1963]

Cpapian, I checked the supplier site that I sent you and under the section "Why shop with us?" they state: "Complimentary Quotes: Need an itemized quote for your Insurance Company? Get in touch with us, we'd be happy to produce one for you, free of charge"

[Cpapian]

O! Good. I knew I liked them. I didn't look at that page last night.

Thanks