Insurance won't allow me to get Swift II

Guest · Post by **Guest** » Tue Jul 14, 2009 9:25 am

Anyone besides me run into a insurance company and/or their designated DME telling you that they will no longer supply you with a ResMed Mirage Swift II ?

Background...
My insurance is BCBS of Michigan, the plan on have is called UM Premier Care. This is a BCBS 'Blue care' plan apparently provided only to University of Michigan employees. Northwood handles ALL DME claims for this plan. Not sure how many other BCBS 'plans' use Northwood as a exclusive DME provider, but as I understand it, this policy is across Northwood as a whole.

Now I've been using CPAP for nearly 2 years. The ResMed Swift II was my mask of choice and I was very happy with it... My insurance covers a new mask (complete with all head gear, etc..) every 3 months and new pillows every month in which I don't get a whole new mask.

When the Swift LT came out I decided to try one, so I went to my DME and tried one in the office, it felt great.... and I was really enthused about the LT. However after about two weeks of trying the LT at home, I found it not be nearly as leak resistant as I have found the Swift II. (my pressure is 10CM and at the time was straight CPAP no AutoPAP). I called the DME to get my choice of mask set back to the Swift II, so that I would get new pillows for the Swift II when the next monthly automatic supply delivery was sent.

The next month I get no new pillows delivered to me... another month goes by and I'm sent pillows for the swift LT, so then I get on the phone to call my DME and find out why they sent me the wrong pillows and how to get them replaced. They tell me they no longer carry the Swift II and that the Swift LT has replaced the Swift II. They go on to tell me that the Swift II is being discontinued. So I call up ResMed and ask if they are discontinuing the Swift II and they tell me that it's not being discontinued.

Long story shorter... I have been told by my insurance company that Northwood handles ALL of the DME claims. Northwood tells me that they consider the Swift II a 'luxury' item and that I can't get one. My insurance will not give me anything in the way of paying/reimbursement if I should choose to buy a Swift II on my own. That is, because Northwood considers the Swift II a luxury item it is NOT a covered benefit.

I have switched to the Opus 360 and have been having OK results with it, however I REALLY want to use a Swift II, yet can't really justify spending 100% out of pocket to get a CPAP mask that seemly should be covered by my insurance.

Now why on earth would the Mirage Swift II be considered a luxury item??? The only thing I can figure is that the Swift II comes with a reasonably nice fabric pouch that you can place the mask/headgear in and zip up when you travel. The Swift LT does not come with that type of pouch, etc...

Has anyone besides me been told you can not get your favorite CPAP mask because it's considered a luxury item?

Yes, I'm mad as heck... but after spending nearly 5 hours on the phone with BCBS, Northwood, and the local DME office, I'm pretty well convinced no amount of my trying to tell them that I want a Swift II, will help... I've more or less given up trying to get a Swift II... but I'm not happy.

Babette · Post by **Babette** » Tue Jul 14, 2009 9:41 am

Yeah, it's called buying it out of pocket. We all run into this. It's just frustrating, but there you go.

Your choice is either buy the thing you want and fight with the insurance later, or settle for what they want to give you. Your call.

Keep an eye out on cpapauction.com, you might pick up a bargain. Also http://www.craigslist.org

Cheers,
B.

Babette · Post by **Babette** » Tue Jul 14, 2009 9:42 am

Well, looky what I just found.....

http://seattle.craigslist.org/sno/hab/1260389084.html

LOL,
B.

sleepy42 · Post by **sleepy42** » Tue Jul 14, 2009 9:55 am

That's a Swift LT isn't it? I don't want a Swift LT... I can get a Swift LT from my insurance company/DME... I can't get a Swift II which is what I want.... but hey, I may have a new unopened Swift LT for sale myself soon...

Babette wrote:Well, looky what I just found.....

http://seattle.craigslist.org/sno/hab/1260389084.html

LOL,
B.

6PtStar · Post by **6PtStar** » Tue Jul 14, 2009 9:55 am

Barbera, I think you have it reversed. The LT is what the DME is supplying. What is wanted is the Swift II. Keep looking!!!!

Babette can find anything!! Just ask!! Her resorces are unbeliveable!!

Jerry

LinkC · Post by **LinkC** » Tue Jul 14, 2009 10:11 am

This may be OT, but I sure wish craigslist would allow a "global" search of all their city sites!!! I don't mind buying by mail, but I sure don't have the time or patience to search all 367 cities!

DreamStalker · Post by **DreamStalker** » Tue Jul 14, 2009 11:29 am

LinkC wrote:This may be OT, but I sure wish craigslist would allow a "global" search of all their city sites!!! I don't mind buying by mail, but I sure don't have the time or patience to search all 367 cities!

In google search box enter:

"item of interest" : craigslist.com

... for a global search of craigslist.

sleepy42 · Post by **sleepy42** » Tue Jul 14, 2009 11:48 am

FYI I know I can find a mask online... it just seems crazy to me that a Insurance/DME can just up and decide that they will not cover a CPAP mask. To me, it's a bit like a insurance company telling you they won't pay for drug x, but will pay for drug y. If Drug x is the one that works the best , then why on earth shouldn't you be able to get drug x, and be forced to use drug y?

It's even worse when I know that the two masks in question have the exact same retail price. To tell my that the Swift II is a luxury item is just ludicrous.

Babette · Post by **Babette** » Tue Jul 14, 2009 12:13 pm

Okay, sorry, you're right. I didn't read your post right.

I think the reality is that the older Swift model is being discontinued. I don't know why they don't just come out and say that, but that's my feeling on it. I just sense the trend.

As for why insurance companies do ANYTHING, honestly, I don't have the energy or the time to figure that one out.

I'm saving them THOUSANDS of dollars by buying my xpap equipment and supplies out of pocket and submitting for reimbursement. But they will only reimburse me 70%. And last time, they questioned me all over the place about my claim. I submitted about 37 pages of documentation and a few months later a check arrived....

I am thankful I have what I have. And I have GOOD insurance. But it's not great. And I have resigned myself to the fact that it never will be.

Good luck!
B.

DreamStalker · Post by **DreamStalker** » Tue Jul 14, 2009 12:24 pm

sleepy42 wrote:FYI I know I can find a mask online... it just seems crazy to me that a Insurance/DME can just up and decide that they will not cover a CPAP mask. To me, it's a bit like a insurance company telling you they won't pay for drug x, but will pay for drug y. If Drug x is the one that works the best , then why on earth shouldn't you be able to get drug x, and be forced to use drug y?

It's even worse when I know that the two masks in question have the exact same retail price. To tell my that the Swift II is a luxury item is just ludicrous.

... and so what exactly were you expecting from a broken healthcare system.

BadBreath · Post by **BadBreath** » Tue Jul 14, 2009 12:28 pm

DreamStalker wrote:
LinkC wrote:This may be OT, but I sure wish craigslist would allow a "global" search of all their city sites!!! I don't mind buying by mail, but I sure don't have the time or patience to search all 367 cities!
In google search box enter:

"item of interest" : craigslist.com

... for a global search of craigslist.

Actually in google you would type "cpap site:craigslist.org" or more specifically in this case "swift II site:craigslist.org".

You can search all of the catergories of a local craigslist site in google by including the local name like "cpap site:sfbay.craigslist.org".

Any subject item will work like "headphones site:craigslist.org". And you can search any site this way. The most effective way to search cpaptalk.com would be in google with something like "swift II site:cpaptalk.com".

Guest · Post by **Guest** » Tue Jul 14, 2009 12:28 pm

Yes, well this again is what really gets my goat... I can not get reimbursed for any percentage. They consider the Swift II luxury and therefore it is not a covered item.

Now, I don't totally disagree with you that the Swift II may very well be going to be phased out. However when I called ResMed they insisted it's not. Partly why I started this topic was to find out if anyone else was being told that their DME is no longer providing/getting the Swift II.

Babette wrote:Okay, sorry, you're right. I didn't read your post right.

I think the reality is that the older Swift model is being discontinued. I don't know why they don't just come out and say that, but that's my feeling on it. I just sense the trend.

As for why insurance companies do ANYTHING, honestly, I don't have the energy or the time to figure that one out.

I'm saving them THOUSANDS of dollars by buying my xpap equipment and supplies out of pocket and submitting for reimbursement. But they will only reimburse me 70%. And last time, they questioned me all over the place about my claim. I submitted about 37 pages of documentation and a few months later a check arrived....

I am thankful I have what I have. And I have GOOD insurance. But it's not great. And I have resigned myself to the fact that it never will be.

Good luck!
B.

Machine	Mask	Humidifier

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Insurance won't allow me to get Swift II

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