Will my new insurance pay for my cpap?

[mtb211]

Hi everyone,

I just received new insurance, Independent blue cross blue shield ppo personal choice, There is no pre existing condition contract saying they will pay for any existing condition.

My old insurance paid 50 percent of my machine, Im trying to read the benefits, Is a cpap machine labled as durable medical equipment? or something else

thx all

matt

[rjjayrt]

A xpap achine is Durable Medical Equipment. As far as if your insurance will pay for it, depends on your contract with them.

[mtb211]

cooli

people here say there is no way they wont pay, i find that hard to believe because insurance companies love screweing me, Im not sure why that is

[YawnGirl]

Call and ask them. That's what I did.

[mtb211]

thats one thing I miss about living in germany, you dont have to pay for a thing

[jmelby]

CPAP is considered durable medical equipment, but a lot of times insurance companies have more specific coverage rules for CPAP than generic dme. The only way to find out for sure is to call as this info is usually not available in the generic benefit plan info.

[gasp]

Most insurance companies have people you can call to ask what your durable medical equipment (and supplies) coverage. I let them know to speak slowly as I am writing it down. I also ask if there is a document online I can refer to or if they have a document they can send me that explains this coverage.

Best wishes!

[Jaylee]

Yes it is listed as DME.

My insurance changed about 5 days before I got my machine. My new company did not consider it pre existing but I think I got through on a time loophole. They only pay 50%, my old insurance was better, but I didn't have much choice in that because my H lost his job.

[capbanks]

I always thought I had great insurance. But, when I needed to get a bi-level machine I found out it wasn't that great after all. My company has a contract with a DME supplier and I was told the machine had to come from them. My insurance would only pay the first $500. When I talked to the DME supplier I was informed that after the insurance picked up the first $500 I would be obligated to rent the machine for 10 months at $190 per month, then I would own it. The couldn't even tell me what machine they would supply. So, in reality, the DME supplier is getting $2400 for a machine that, by my research, costs a little over half if I were to buy it myself. I simply couldn't afford to either buy it outright or pay $190 per month so I borrowed a family member's back-up machine. Well, his good machine went south so I will be giving it back to him. I bought a used Respironics Tranquility bi-level and if I can figure out how to adjust it I'll use that.

[el_zorro]

Hi everyone,

I just received new insurance, Independent blue cross blue shield ppo personal choice, There is no pre existing condition contract saying they will pay for any existing condition.

My old insurance paid 50 percent of my machine, Im trying to read the benefits, Is a cpap machine labled as durable medical equipment? or something else

thx all

matt

I know every insurance plan is different, but i have the blue cross blue shield national ppo (through BCBS of Massachusetts). Have had this insurance for 10 years. I have a $350 a year deductable (2 sleep studies took care of that). They should end up paying 90% of the new machine. I chose a DME in network so it made it easier. I lucked out on the DME, they normally offered 2 machines (ResMed S8 Elite II w/humidifier) or (Philips Respironics System One Remstar Pro). I got a PR Remstar Pro as my primary.

From the invoice it looks like they will bill BCBS $944 *including a ResMed Softgel nasal mask), but the DME guy said that the amount allowed by BCBS will be less. I am expecting to pay under $100 for the whole setup. I will let you know how it turns out once I get the final bill.

Then I was looking for a backup/travel machine. I really got lucky on that, on cpapauction.com I received a brand new S8 Autoset II w/humidifier and a Respironics Comfortgel Nasal Mask for $200 including shipping. I'm pretty happy about that deal also. If I like this machine better or a lose a little weight and the Autotitration helps me lower the pressure a little I might end up using this machine full time.

So hopefully for $300 combined I have two good data capable machines that should last for at least 5 years and two masks that should last for a year.

[Jaylee]

I always thought I had great insurance. But, when I needed to get a bi-level machine I found out it wasn't that great after all. My company has a contract with a DME supplier and I was told the machine had to come from them. My insurance would only pay the first $500. When I talked to the DME supplier I was informed that after the insurance picked up the first $500 I would be obligated to rent the machine for 10 months at $190 per month, then I would own it. The couldn't even tell me what machine they would supply. So, in reality, the DME supplier is getting $2400 for a machine that, by my research, costs a little over half if I were to buy it myself. I simply couldn't afford to either buy it outright or pay $190 per month so I borrowed a family member's back-up machine. Well, his good machine went south so I will be giving it back to him. I bought a used Respironics Tranquility bi-level and if I can figure out how to adjust it I'll use that.

Yep it sucks to "rent" a machine for $200 a month *my insurance pays another $200 a month* when you can buy it outright for $1400 I think that should be illegal. But I don't have the $1400 right now so I am screwed.

[capbanks]

I always thought I had great insurance. But, when I needed to get a bi-level machine I found out it wasn't that great after all. My company has a contract with a DME supplier and I was told the machine had to come from them. My insurance would only pay the first $500. When I talked to the DME supplier I was informed that after the insurance picked up the first $500 I would be obligated to rent the machine for 10 months at $190 per month, then I would own it. The couldn't even tell me what machine they would supply. So, in reality, the DME supplier is getting $2400 for a machine that, by my research, costs a little over half if I were to buy it myself. I simply couldn't afford to either buy it outright or pay $190 per month so I borrowed a family member's back-up machine. Well, his good machine went south so I will be giving it back to him. I bought a used Respironics Tranquility bi-level and if I can figure out how to adjust it I'll use that.

Yep it sucks to "rent" a machine for $200 a month *my insurance pays another $200 a month* when you can buy it outright for $1400 I think that should be illegal. But I don't have the $1400 right now so I am screwed.

I bought the used Tranquility on Craigs List from an estate sale. I think I paid $40 and it only has about 200 hours on it. I also was sent a link to the service manual from someone on this forum and was able to adjust it to my specs. I just need to find a heated humidifier now. I'm thinking a hot plate and a coffee can. Hey, gotta do what I gotta do being on a fixed income.

[Jaylee]

I always thought I had great insurance. But, when I needed to get a bi-level machine I found out it wasn't that great after all. My company has a contract with a DME supplier and I was told the machine had to come from them. My insurance would only pay the first $500. When I talked to the DME supplier I was informed that after the insurance picked up the first $500 I would be obligated to rent the machine for 10 months at $190 per month, then I would own it. The couldn't even tell me what machine they would supply. So, in reality, the DME supplier is getting $2400 for a machine that, by my research, costs a little over half if I were to buy it myself. I simply couldn't afford to either buy it outright or pay $190 per month so I borrowed a family member's back-up machine. Well, his good machine went south so I will be giving it back to him. I bought a used Respironics Tranquility bi-level and if I can figure out how to adjust it I'll use that.

Yep it sucks to "rent" a machine for $200 a month *my insurance pays another $200 a month* when you can buy it outright for $1400 I think that should be illegal. But I don't have the $1400 right now so I am screwed.

I bought the used Tranquility on Craigs List from an estate sale. I think I paid $40 and it only has about 200 hours on it. I also was sent a link to the service manual from someone on this forum and was able to adjust it to my specs. I just need to find a heated humidifier now. I'm thinking a hot plate and a coffee can. Hey, gotta do what I gotta do being on a fixed income.

It is nice to meet someone else on BiPap You got a great deal on yours! We don't have Craigs List in my area, I have looked.

[ken s]

Matt-
My prediction is that the insurance company will try to screw you like they did me.
I've had a Respironics for almost 10 years that was beginning to make noise. So...
I called my PPO Medical Group here in Santa Cruz, CA. I have Blue Shield through them. I got my primary MD to write the prescription, the medical group authorized the purchase and then referred me to Apria, which supplies the equipment. Apria said they have contracted rates nation wide and cost of equipment depends on rate with each provider.
So i jumped through the PPO hoops and got prescription, authorized, talked to Apria,blah blah blah. As I expected, (this happened a few years ago) Apria's CPAPs
cost between $900-$1200. My insurance covers 50%. So, much more expensive than buying online and getting the next day. I bought a new Respironics C Flex with heated humidifier for under $500 and delivered next day.
The insurance was no benefit.

Good luck and let us know what happens in your case.

Thanks!

[CorwinBrown]

I think it is mostly depend upon the Contract. As per the Contract, the company will pay for the new Insurance.