Insurance stuff

[Barbee]

For the past several months I have been having issues with my DME. They refuse to order the mask I want. Never have gotten a new humidifier, on and on. While visiting the sleep Dr, I let out my frustration about them and she said “let me send them an Rx for that particular mask and see what happens” Still refused and it seems to me I should not have make do with the masks they carry so I told them to flake off.
So today I called my insurance company and explained what was going on and they allowed that I can order from cpap.com and they will reimburse me. I need a claim form, the insurance billing codes, and the prices I paid, and my name on the receipt.

So now I need an idea of what supplies I can order and how often. I believe the former DME used the Medicare schedule. I wont need supplies that often but dont want to order something too soon.

I feel free

[ChicagoGranny]

So today I called my insurance company

Was the DME in your insurance network?

I feel free

Good for you!

[Barbee]

So today I called my insurance company

Was the DME in your insurance network?

I feel free

Good for you!

Yes the DME is in network.

[ChicagoGranny]

Yes the DME is in network.

They should be reported to your insurance company for being unwilling to fill your prescription.

[Pugsy]

cpap.com use to send out, via email, a printable universal insurance claim form that you could use to file with your insurance company.
I don't know if they still do that or not....call them up and ask them.
If they do...it will pretty much have everything you need to file insurance already on it.

[prodigyplace]

Yes the DME is in network.

They should be reported to your insurance company for being unwilling to fill your prescription.

They should be reported to the state regulators. Refusing to fill a prescription for devices they are licensed to sell may be a violation.

[Barbee]

Yes the DME is in network.

They should be reported to your insurance company for being unwilling to fill your prescription.

I told them alll about it

[Barbee]

cpap.com use to send out, via email, a printable universal insurance claim form that you could use to file with your insurance company.
I don't know if they still do that or not....call them up and ask them.
If they do...it will pretty much have everything you need to file insurance already on it.

The last 2 times I ordered from them, the receipt had everything I would need to file a claim. But I will attach that paper to my insurance claim form..just to be safe!

[prodigyplace]

It looks like cpap.com has tried to make insurance easy. I have not tried this though.

https://www.cpap.com/cpap-insurance-claim-form

[Barbee]

It looks like cpap.com has tried to make insurance eay. I havenot tried this though.

https://www.cpap.com/cpap-insurance-claim-form

Thank you! I had not noticed that page before!

[chunkyfrog]

I tried it with BCBS.
It did NOT work.
Maybe it's just the company.

[Barbee]

I tried it with BCBS.
It did NOT work.
Maybe it's just the company.

I asked if I could turn a claim in quarterly instead of each time I ordered something. The answer I got was yes. We will see how it goes...

[Janknitz]

Yes the DME is in network.

They should be reported to your insurance company for being unwilling to fill your prescription.

They should be reported to the state regulators. Refusing to fill a prescription for devices they are licensed to sell may be a violation.

You should file WRITTEN complaints with both the state regulators and your insurance company (verbal complaints do nothing). They are CONTRACTED to provide the DME your doctor prescribes to insured individuals, and they refused. And they refused to provide medically prescribed equipment they are licensed to provide.

If you don't have it in writing from your insurer that they will reimburse you for purchases from cpap.com, it might be a little shaky. So don't go hog wild on purchases until you are assured they will honor what they told you.

You can order a copy of your "Evidence of Coverage" document by contacting the insurance company and requesting it. That's the contract the insurer has with you, even though you've never seen it. The document may be available on line, or they will have to send it to you. I print it out every year. If that document says they will reimburse you for out of network purchases, then you have backup if they deny it.

[Barbee]

Yes the DME is in network.

They should be reported to your insurance company for being unwilling to fill your prescription.

They should be reported to the state regulators. Refusing to fill a prescription for devices they are licensed to sell may be a violation.

You should file WRITTEN complaints with both the state regulators and your insurance company (verbal complaints do nothing). They are CONTRACTED to provide the DME your doctor prescribes to insured individuals, and they refused. And they refused to provide medically prescribed equipment they are licensed to provide.

If you don't have it in writing from your insurer that they will reimburse you for purchases from cpap.com, it might be a little shaky. So don't go hog wild on purchases until you are assured they will honor what they told you.

You can order a copy of your "Evidence of Coverage" document by contacting the insurance company and requesting it. That's the contract the insurer has with you, even though you've never seen it. The document may be available on line, or they will have to send it to you. I print it out every year. If that document says they will reimburse you for out of network purchases, then you have backup if they deny it.

Great idea. Thank you!

[zonker]

So now I need an idea of what supplies I can order and how often. I believe the former DME used the Medicare schedule. I wont need supplies that often but dont want to order something too soon.

I feel free

well, i think i may be misunderstanding this part. do you mean how often you should order supplies or how often they will want you to order supplies?

if the later, dunno. if the former, i think you've been on board here long enough to know we don't blow through supplies all that often.

and just browse through cpap.com and see what they have on hand.