Insurance and buying equipment online

Janelle · Post by **Janelle** » Sun Jan 16, 2005 6:29 pm

Since I just discovered I seem to be renting my current APAP, all may not be lost as far as getting the software and getting the insurance to pay for it. My question is, how does that work with insurance when you buy something online. Will Cpap.com or others apply to your insurance or do you have to pay for it up front and then file the insurance claim yourself for reinbursement?

snamvar · Post by **snamvar** » Sun Jan 16, 2005 6:36 pm

cpap.com does not deal with insurance. You need to pay up-front and then get reimbursed from your insrance company. It's is best to check with your insurance company ti make sure it is ok.

wading thru the muck! · Post by **wading thru the muck!** » Sun Jan 16, 2005 6:42 pm

Jannelle,

This question is right up my alley. First contact your insurance co. and tell them you would like to buy a machine online when your rental period is over. Ask them how you would go about submitting a claim yourself and of course if they allow that. If they balk, remind them that the machine is MUCH cheaper if you buy online. Probably less than half the price of the DME you are renting from. (If you like get a quote from your DME first so you can quote actual numbers) If they give you the go ahead you will have to purchase and pay for your equipment up front. cpap.com will send along an invoice showing the equipment you purchased with all the appropriate billing codes for insurance filing. When you get all the appropriate paperwork fill out the insurance submittal and send it along with copies of all your documentation including any insurance pre-approvals and your prescription. Be prepared, it may take a couple of months to get your money from the insurance company. Keep after them checking to make sure they are processing your claim every couple of weeks or so. Along the way make sure you document all your calls and get names of everyone you talked to. If you run into problems they seem to disappear if you can quote someone by name who will have to answer for what they told you.

Good luck!

Guest · Post by **Guest** » Sun Jan 16, 2005 7:25 pm

Also, consult your insurance manual. I know that BC/BS will pay no more than 60% of the approved amount for a CPAP that is purchased through an "out of network " supplier.

Mikesus · Post by **Mikesus** » Sun Feb 13, 2005 8:08 am

Anonymous wrote:Also, consult your insurance manual. I know that BC/BS will pay no more than 60% of the approved amount for a CPAP that is purchased through an "out of network " supplier.

That varies plan to plan. I have 80/20 coverage but the 80 is of the Maximum Allowable Charge. You can try to call your insurance co and get that amount but without the specific billing code you won't get a correct answer. CPAP.COM puts the billing codes on your receipt...

Liam1965 · Post by **Liam1965** » Sun Feb 13, 2005 8:24 am

It really depends on your company and your plan.

My company won't buy, only rent-to-own. 10 months of rental at their prearranged price and it's yours, and you can only do that with a preferred provider.

On the other hand, my coverage limit (you'll want to look this up) on durable medical equipment is $700/year, so it's honestly cheaper for me to buy the equipment outright from cpap.com than it is to go the rental route and have the insurance kick in $700 towards the now-inflated-by-$1200 prices.

Liam, who wouldn't live without insurance, but finds it hard to live WITH it as well.

wading thru the muck! · Post by **wading thru the muck!** » Sun Feb 13, 2005 8:45 am

Smart move to go the route that's cheapest for you, even if it does let your insurance company of the hook.

I saved my insurance company thousands of dollars and in turn the nickel and dimed my claim (thanks guys), but I still came out spending less.

The big losers are the evil DMEs

Mikesus · Post by **Mikesus** » Sun Feb 13, 2005 9:20 am

Well my DME told me that my insurance co would ONLY allow rent to own, but yet when I talked to my insurance co, they had already APPROVED a purchase in addition to rental. Call your insurance company to find out.

I guess I am lucky I have $5,000 yearly DMG coverage, but if I go out of network I have to meet a $200 deductible.

So for my Resmed Auto Pro Cflex I am looking at a claim of $1000 (they won't cover the software ) and then 80% of the allowable charge - $200. So if they only allow $800 for the machine mask and filters I am looking at around $480 back. So $520 + $200 software is about equal to the $500 or so that I would end up paying for a Fisher Roadkil from my DME. Is it worth the extra $220ish or so? You betcha!

MichaelM · Post by **MichaelM** » Sun Feb 13, 2005 11:10 pm

Definately call your insurance carrier and learn their policy.

I will be trying the CPAP route soon. My insurance company has told the provider they will rent for the first three months. If all goes well, they will then buy the machine for me. (all at allowed amounts).

My company will not pay for online equipment even though they know it would be less expensive.

MaskedMechanic · Post by **MaskedMechanic** » Mon Feb 14, 2005 4:39 am

My company will not pay for online equipment even though they know it would be less expensive.[quote]

Interesting. Wonder why? Insurance forcing higher price deal? Stange! What is this all about?

Mikesus · Post by **Mikesus** » Mon Feb 14, 2005 5:49 am

MaskedMechanic wrote:My company will not pay for online equipment even though they know it would be less expensive.

Interesting. Wonder why? Insurance forcing higher price deal? Stange! What is this all about?

Some policies do not allow out of network coverage, I would suspect that would be the reason...

Janelle · Post by **Janelle** » Mon Feb 14, 2005 6:45 am

usually they will allow out of network coverage, but not at the same percentage as Network coverage. Make sure you talk to someone at your insurance customer service who seems to know what they are talkig about, AFTER reading the insurance booklet, most of which are available online. Seems they don't want to be out the cost of printing one and sending it to their subscribers these days. You might even have to go to a supervisor to get some concrete answers.

They will not deal directly with the online provider because it is out of network, but generally, you can submit a bill with the correct codes needed, and they will pay a percentage minus any deductible you are responsible for and also minus any rental payment they have made on another machine through a DME

As one supervisor told us when we were having some problems getting answers and obviously getting a lot of mis-information, "Don't ever deal with anyone in Customer Service, they don't know anything!"

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