"How to change masks" ???

Mike1953, I'm really surprised you know all of the individual insurance policies regarding reimbursement. Some have reported here that their's have reimbursed for out of network expenses at a reduced rate. If you are talking about Medicare that's not what the OP was asking about.

Hey we have another know it all. They all come out at night around here.

OkyDoky wrote:Mike1953, I'm really surprised you know all of the individual insurance policies regarding reimbursement. Some have reported here that their's have reimbursed for out of network expenses at a reduced rate. If you are talking about Medicare that's not what the OP was asking about.

his argument, and insults at pugsy pretty much confirm that particular induhvidual doesn't know shit...

Well...I have always said there are 2 things I can't fix...lazy and stupid.
Maybe I need to add buttheads aka assholes to the list but never really thought too much about it since they usually fall in the stupid category anyway.

I guess cnaumann getting reimbursed for expenses paid to secondwindcpap.com (whom I am sure isn't in network for anyone) for his ASV machine must have been an imaginary check from BCBS that went into his bank the other day.
But then what do I know..I am just a stupid woman who can't read her own insurance policy...and spent 10 years dealing with insurance and filing claims and a bunch of other stuff regarding various insurance plans.

To Frayed Train...do check with your insurance directly to see just how they handle in and out of network expenses.
Despite what Mike says...it can vary widely among plans.

Pugsy wrote:

mike1953 wrote:End of discussion.

That part is correct. I don't have a 2 X 4 big enough to fix things in this situation and you aren't worth the effort.
Some things can't be fixed.

I've been waiting to tell you you're wrong about something, Pugsy... *snork* I got a hammer that can fix almost anything. "Diamonds are forever. Hammers are permanent."

I also try to wait til you're WRONG about something before turning on the "raging bitch" switch...Nice to see others will take that sucker for a test every now and again so I don't have to. Because really...you're not wrong very often. Must be nice.

Pugsy wrote:

mike1953 wrote: Exactly what I just said, you don't get reimbursed what you paid for your our of network expense.

No...that's not what I said. There's a big difference between "no reimbursement it's all out of your pocket" and reimbursed at a reduced rate. It all depends on the insurance plan. I have out of network reimbursement at 60 % for out of network vs 80% for in network.

mike1953 wrote: Out of network is just that out of network. No pay no reimbursement its all out of your pocket period.

I pay 10% in network and 30% for out of network. The replacement schedule states so many cushions/pillows per time period, one mask per time period, etc. I'm not looking to get replacement parts for both masks at the same time, just want to direct my scheduled replacement to the mask that I need the replacement for. I know others have switched masks, and wondered how they did it. I see that most have paid out of pocket through a vendor that gave a much better price than the local DME. When it comes down to it, I want to get the most value from my insurance dollars but at the same time, do things that are convenient for me. If I'm going to have to spend time going round and round with the DME, then the money saved isn't worth it and I'd go with an online vendor or local retail outlet if they have a fair price.

If I find any information on how this works, I'll try to pass that along to the group.

When I had BCBS, our contract DID have provisions for reimbursement for out of network.
The deductibles were double, and the copays were double.
I tried to make it happen, but the numbers were ridiculous.
Maybe someone with a better contract could do it, but in my case,
--the stick was too long and the carrot too small.
Technically, it was out there, but a waste of my effort.--maybe not for everyone, though.
Never say "NEVER". --and remember when you call people names, it only describes YOU!

I went to the DME today. They said I could switch to a new mask in 3 months, and could do so every three months. Since I would have a 'new' mask they wouldn't send the 3 months worth of supplies but wait until I was satisfied with the change then resume the 'standard replacement schedule'.

chunkyfrog wrote:When I had BCBS, our contract DID have provisions for reimbursement for out of network.
The deductibles were double, and the copays were double.
I tried to make it happen, but the numbers were ridiculous.
Maybe someone with a better contract could do it, but in my case,
--the stick was too long and the carrot too small.

In my case the deductible for out-of-network is $1500 rather than the in-network $750. I have blown right through my in-network deductible already this year (colonoscopy does that...) but the out-of-network is a totally separate deductible that still starts at $0. So if I submitted the $26 I spent at cpap.com for machine filters, I would still need another $1,474 in out-of-network spending before I would even make it to the top of THAT deductible.

I can imagine where it might matter -- I get some really exotic disease and need treatment out-of-network and DO make it through my deductible. Then it is worthwhile to go back and pull out and submit the cpap.com bill so I would only need to pay $1474 more rather than $1500.

But that's pretty unlikely...