insurance help

Hello All,
My insurance question is:

I have Aetna PPO they keep running me around- Does anyone have an Aetna PPO plan that has been reimbursed ?? I know if it Out of Network I have a 60- 40 plan (60% them 40% Me)

Thank You
Pete

Yes Pete, I too have this plan. Its our 'group health' plan, but it also comes with a
$2,000.00 deductible that all my DME charges have been applied to.
Seven expensive months later, after I knew what cpap was best suited for me,
I returned their 'rental' and purchased from a private seller.
If you have a direct question, this is a great place to start as many in this
forum have delt with all sorts of issues.

Do you have a physical copy/original of your prescription?

With those kinds of percentages, you will most likely be better off purchasing a machine and all of your accessories and supplies from an online supplier like https://www.cpap.com

Local brick and mortar suppliers' prices are about 2 1/2 - 3 times the price of online suppliers.

So......do the math.

Den

WOW that was quick-- At this point I have a 144.00 dollar deductable (600) for the year. Im just wondering if they will cover a purchase as appose a rental. To be clear with my question, if I spent the money (at https://www.cpap.com) for a full system, paid my 144.00 deductible will they reimburse the 60% for that purchase

1000.00
subtract 144.00 = 856

Will the insurance do a 60/40 split the 856 if i buy at https://www.cpap.com

Thanks All

Call your insurance and ask.

Different companies have different policies and depends upon your coverage.

I know I had Blue Cross and Blue Shield (union paid) when I started therapy and they rented my machine for x number of months. Our coverage was due to run out at the end of the 2007 year and so I called and asked if there was a way to purchase my machine outright instead of doing the rental (I had my machine since Aug 30, 2007). They agreed and so my machine ended up costing me a total of $15.00 or so. I lucked out.

You won't know until you ask -- what can they do but give you an answer you don't like and who knows may give you a surprise that will make you kick up your heels in delight when it is the answer you want.

Rockylinx wrote:WOW that was quick-- At this point I have a 144.00 dollar deductable (600) for the year. Im just wondering if they will cover a purchase as appose a rental. To be clear with my question, if I spent the money (at https://www.cpap.com) for a full system, paid my 144.00 deductible will they reimburse the 60% for that purchase

1000.00
subtract 144.00 = 856

Will the insurance do a 60/40 split the 856 if i buy at https://www.cpap.com

Thanks All

You'll have to ask them. What many of us have done in the past is to order from CPAP.COM (charge it to our credit cards) and then create an invoice (from us as the billing party) to our insurance providers (with them as the party being billed). It's best to get all of this worked out with them ahead of time so there are no surprises.
When creating the invoices, you would need to put the insurance billing codes on it, but since CPAP.COM includes those codes on their invoices, one can practically duplicate the CPAP.COM invoice with the appropriate changes of the bill-er and the bill-ee.

It worked for me.

Den

Some insurance companies require you to rent a machine for a certain period of time, to be sure you are really going to use it, and be compliant, before they pay for it in full. You'll want to see if your insurance company has this requirement or not. Good luck!