CPAP and BCBS

[Janknitz]

I don't think you can judge what BCBS will pay in your case from others' experiences because EVERY PLAN (even within the same insurer) is different.

But here's a little bit of basic insurance 101:
You stated your insurer has preferrd-providers. That means that BCBS has a contract with those providers to provide machines and equipment to you AT A CONTRACTE PRICE. BCBS will pay 70% of that contracted price, you pay the remaining 30% plus any deductibles.

The price the DME charges, and the price they are contracted to provide the machine to BCBS insureds are two different animals. The price you can buy the equipment for yourself online hs NOTHING to do with this BCBS-DME contract.

You need to call BCBS and ask, for YOUR plan, the following:
1. Does BCBS specify different rates for differnt CPAP/APAP machines or do they allow a set fee for ANY machine within the E0601 HCPCs code (billing code for CPAP/APAP)? Most insurances will pay a set amount no matter what machine you get within that E0601 code, BUT some insurances--particularly HMO's--pay only for a particular machine.

2. Ask how much the allowable fee is. that will permit you to calculate your 30% copay (alternatively, you can ask "what is my out of pocket cost going to be?") Remember the DME will charge the machine, humidifier, hose, and mask (and sometimes each component of the mask!) separately. Some insurers (and Medicare) insist that you rent your machine on a capped rental basis, but you buy the rest (humidifier, hose, mask) outright.

Now you have some homework to do. Calculate your out of pocket cost for deductibles (remember, you may have a second deductible to meet in the new calendar or fiscal year) and co-pays, and whehter or not you will have a choice of machines (if the insurer pays by HCPC's code you will, but the DME may pretend you don't). Then decide if it's even worth having your insurance pay if you can buy your choice of machine out of pocket more cheaply. You might also consider "letting" the insurance pay 70% of the humidifier and buying the machine online if that works better for you financially.

[Mask2sleep]

BCBS Federal employee plan here, near Annapolis, Maryland. So far since July I’ve had a sleep study, a titration, a BiPAP machine, and multiple masks (Quattro FFM, Comfortgel nasal, Forma FFM, and now a Mirage Liberty Hybrid FFM) and I was referred to 1st Class Medical which is located in northern Virginia as my DME. So far I haven’t seen a single bill come to me and the DME has been great. Every day I worry there’s going to be a bill in the mail but none yet!

[2ndGenCPAPgal]

I second the recommendation for 1st Class Medical. (feel free to PM me for more info)

They consider APAPs "different therapy", but they at least provide data capable machines and prompt courteous service. I too have never gotten a bill from them for a balance.

[Mask2sleep]

Ditto. I am on first name basis with the techs, customer service folks and their head clinician. Very prompt and nice.

[cpapdadoftwo]

I've been on CPAP for just over 10 years and have gone through a few DME companies in my time. Some are awful after initial service, seems like they just don't care about you once they get you your machine and bill for it. A friend told me about 1st Class Med and they're smaller ocmpany, but great customer service and even come to your work place if you can't meet at home. Generally doesn't take more than a couple days for them to come meet me if i want to try a new mask or my BiPAP device is not working. i must have tried at least 5 diff masks the past 2 months, they're pretty patient Good company, not perfect, but way better than lincare or aprea.

[msradar65]

I have BCBS of Louisiana. I had all kinds of problems getting the sleep study approved and paid for. It took two months. I have a high deductible. So my machine and supplies cost me $300. I just changed jobs so I have BCBS anthem out of California now. So we shall see how they handle paying for supplies.

They do vary dramatically I am learning.