BCBS purchase or rent.....

I have had insurance through the CCN network since before starting cpap therapy. I found out about 3 weeks ago that I would be switching to BCBS. I called my dreaded dme provider and asked about how the changes would effect my cpap. Well, long story short, the dme provider has never billed my insurance for my cpap, mask, supplies etc. They caught on to this little tid bit of information because I called them to ask for details. So, knowing that I would be switching to BCBS as of today, they decided to just start billing my insurance this month. BCBS pays $2000.00 annually for any dme needed either rented or purchased. Is this my opportunity to get out of the dme world and just purchase my equipment from cpap.com? I have a $500 deductible so most of it would be out of pocket. I am sure that the dme is going to charge the insurance FAR FAR more that it would be at cpap.com. The other option would to be to continue to pay $94.00 a month as a rental until my deductible is met. Any suggestions or experience with BCBS? Thanks

Idahogal, my experience with BC/BS was that they initially told me purchases from CPAP.com would not be covered, but upon further questioning decided they would be covered at the out-of-network rate of 60%. When I submitted the bill, they paid 100% for the BiPAP-auto and mask from CPAP.com. Of course, I'd already met my deductible for the year.

Just my experience, of course, and all BC/BS providers and plans are not the same.

Regards,
Bill

idahogal:

i think your dme has to go back to cnn and bill them - you got the equipment under cnn's watch, and it's not your problem if dme didn't bill your insurance company.

is BCBS the same in every state? plus, aren't there different provisions for different policies? I have BCBS HMO in NJ, and they tell me anyway, that they pay 100% of cpap equipment with no deductible or co-payment or whatever. i'm kind of nervous but that's what they say.

caroline

As far as how much anyone can bill your insurance, that is determined by the insurance company - not by the provider.

Of course, it is only common sense that if you are talking about paying for something yourself that you will pay more going through a traditional equipment provider than you would by purchasing something online.

The traditional business has much higher expenses and provides services far beyond what an online retailer will provide, so it stands to reason they will cost more.

Wether or not those services are something you would benefit from and therefore worthwhile to you is something only you can determine.

It sounds like you have an extremely limited restrictive insurance policy. You might want to speak with your insurance company about the abilities to purchase extra coverage since xPAP therapy is a more or less lifetime need

From your post, you make it sound like your equipment provider is going to start billing BCBS for your CPAP. I would check with them to see if what they meant was that they were going to bill CCN for the unit. It is possible they submitted the claim initially, and that CCN denied it. The documentation thresholds for many insurance companies when it comes to xPAP therapy are massive, and many claims get denied the first time or two they are submitted. Add in that many insurance companies will take 3 months or more to process a claim, and you can imagine how long it really can take to resolve these issues.

Overall, you did qualify for a CPAP under CCN guidelines, your equipment provider should be able to get that covered. You did not indicate wether CCN covers the unit as a rental or a purchase. Most insurance companies will purchase a CPAP unit.

That would leave only the cost of supplies being billed through BCBS, which should be well within your coverge limits.

Bingo

Thank you all for so much input!! This is great stuff. I agree that the DME provider should bill CCN first. I don't know why they would not. They have not billed anyone for my equipment. I "fell through the cracks" somehow. My machine is rented right now and I have only been billed for supplies myself. No mask, no machine, no tubing etc. Just for filters. I guess this will be quite a mess before it all gets cleaned up. I had a similar issue with dental insurance as well and am still working on that after 3 million phone calls and 3 months of frustration. I guess all I can do at this point is wait and see how it all unfolds. Thanks again.