New insurance carrier...new CPAP?

[Guest]

I've had a Respironics RemStar auto M series a-flex for about a year and a half. I was with United Healthcare and now I'm with Anthem BCBS. Now that I have a new insurance carrier can I get a new machine? I covet the ResMed S8 Autoset II. Will my new insurance company cover it? Will they know about my old machine? Should I go to a new doctor? Anyone gone through this?

[LinkC]

Those are all questions you should probably direct to your new insurance company. I'll bet they have a customer service number...

[rjjayrt]

Not sure. BCBS usually has to pre approve DME, in other words they take all your info and decide if its medically necessary. They will want your sleep study, this will probably tip them off concerning your original machine. United Healthcare has probably purchased your original machine so they won't be asking for it to be returned. I base this on my knowledge of BCBS, United Healthcare is another matter, I assume they purchase after 30 to 90 days but to be sure you need to check with them. Good news is that in either case you have a decent machine, which isn't all that old.

[Llama]

I also just switched from UHC to Anthem BCBS (Virginia) and was kind of wondering the same thing, although really for masks.

My first DME told me that it would be fine to get a mask now under UHC then another new mask in Jan with BCBS. We switched DME's after a problem with the first one and switched to a local Lincare branch. My wife got a VPAP and a mask under UHC in Dec, but had to try three masks before she got one that worked for her. On her last visit she asked the DME about ordering another mask under BCBS and she was told that "BCBS would see that she *just* got a mask, even under a different insurance and would not cover it".

We are calling BCBS today to find out so I will report their answer as it pertains to my plan.

[Wulfman]

I've had a Respironics RemStar auto M series a-flex for about a year and a half. I was with United Healthcare and now I'm with Anthem BCBS. Now that I have a new insurance carrier can I get a new machine? I covet the ResMed S8 Autoset II. Will my new insurance company cover it? Will they know about my old machine? Should I go to a new doctor? Anyone gone through this?

I would THINK that after all this time, you actually OWN that machine. Even on insurance/DME payment plans, they're paid for in about 10 months.

If it IS paid for, I doubt that a new provider would want to pay for a new one just because you "covet" a different one.
If you really want another one, buy it out-of-pocket. You'll probably need a backup machine at some time in the future.


Den

[Guest]

Those are all questions you should probably direct to your new insurance company. I'll bet they have a customer service number...

Yes, and if they didn't know I had already got a CPAP in the past, they would then. Not sure that's such good advice given the nature of my question.

If it IS paid for, I doubt that a new provider would want to pay for a new one just because you "covet" a different one.
If you really want another one, buy it out-of-pocket. You'll probably need a backup machine at some time in the future.

I'm pretty sure it's paid for. How would my new insurance company know about any of this though? I don't think that my old insurance company would be allow to share my medical history for HIPAA sake. Unless I tip them off, wouldn't I just be able to get a new machine even if this meant going to a new sleep clinic?

[Wulfman]

Part of it would depend on if the existing insurance records are transferred to the new insurance provider. (I would think they would be if it's a group plan)
If they didn't know you had previously had been diagnosed with sleep apnea and already had a machine, they would most likely require you to have a (new) sleep study. (why else would someone WANT a CPAP machine?) That would then make you pay the deductibles under the new plan........it would probably be cheaper to just buy another machine.

Den

[Jaylee]

Well I agree that no one here can really answer your question.

But when I switched insurances, I had to prove that I had sleep apnea, and that meant they had to see my sleep study. I am sure they will figure out that you have a machine from that.

I am not a fan of trying to trick insurance companies, even though I usually hate them. Maybe I am just bitter because of having to pay such an extreme amount for my own machine. I would love to flat out own one, that would be a blessing.

[CorwinBrown]

I am newbie to this site and just started my insurance carrier. Good to see the excellent advices given by the members of the community in respect to the insurance. I hope, these tips will really help me in future.

[JohnBFisher]

... I am newbie to this site and just started my insurance carrier. ... I hope, these tips will really help me in future. ...

Greetings! Welcome to the forum. Sorry we missed this earlier! Sorry you have to be here, but as you can see, it's often easier if you have others who have been through some of the same problems in the past. No guarantees you will not encounter problems. But at least you have plenty of experience here that may make it easier.

Best wishes. And feel free to ask questions as you work on figuring out your sleep issues!

[Guest - Tim]

Hi everyone,

Perhaps this is the place for this question, I'm not sure. All I know is that my wife and I are extremely frustrated over this.

Here's our problem. In May of '09, while my wife was with Blue Shield (through work), she was prescribed a cpap machine. We dealt with a dme company (Apria) and found her a machine and a 10 month contract to go with it. In January, her employer switched carriers to Anthem BC. We had 2 cycles left on the billing contract. Now Apria is saying "since you have a new insurance co., we need to start the 10 months all over again..." Well, BC, we think this is 'BS' !! Has anyone out there had a similar situation ?? I mean, if this is real - and a common practice among insurance companies - then I'm starting to understand why our rates have gone up over 200% in the last 10 years !! This crap has got to stop ! ... or am I just getting erroneous information ??

Thanks for your time. Now I have to go stare at the ocean or something to cool down.

[Wulfman]

Hi everyone,

Perhaps this is the place for this question, I'm not sure. All I know is that my wife and I are extremely frustrated over this.

Here's our problem. In May of '09, while my wife was with Blue Shield (through work), she was prescribed a cpap machine. We dealt with a dme company (Apria) and found her a machine and a 10 month contract to go with it. In January, her employer switched carriers to Anthem BC. We had 2 cycles left on the billing contract. Now Apria is saying "since you have a new insurance co., we need to start the 10 months all over again..." Well, BC, we think this is 'BS' !! Has anyone out there had a similar situation ?? I mean, if this is real - and a common practice among insurance companies - then I'm starting to understand why our rates have gone up over 200% in the last 10 years !! This crap has got to stop ! ... or am I just getting erroneous information ??

Thanks for your time. Now I have to go stare at the ocean or something to cool down.

Did you (specifically, your wife) ever talk to Blue Shield about this before her employer switched insurance providers?
I'm sure you did..... ......so, did you ask them about doing a payout of the balance of the contract before the end of the year?
Have you (specifically, your wife) talked to Anthem since the switch?
Have you two read over your contract with Apria?

NEVER.......accept what Apria tells you (about your insurance) without checking with your insurance.

Probably more bad news.......
How much is the deductible under the new insurance plan/provider?
Since you're under a new insurance provider and it's the beginning of the year, I'm sure there's also going to be a new deductible that will apply.......so until the deductible is met, you're going to be paying the bulk of the payments out of your pockets.

Which model of CPAP did she get from Apria? I'm guessing it was a real, low-end cheap-o (M Series REMstar Plus).

AFTER YOU CHECK ALL OF THE AFORE-MENTIONED......and DO THE MATH.......
You could either try to run a bluff with Apria and tell them you're bringing the machine back unless they consider the contract paid in full........
Or, if they don't want to consider it paid in full, you could then take it back and tell them to "SHOVE IT".....and then purchase a GOOD, DATA-CAPABLE machine from CPAP.COM for what it's probably going to cost you anyway (deductibles and co-pays).

Unfortunately, your story is a common one.

Good luck.


Den