Anyone have Blue Cross Blue Shield for insurance?

Offerocker · Post by **Offerocker** » Mon Sep 11, 2006 3:04 pm

Bookbear: Yes, I know that, but with BC/BS FEDERAL Employee, it is 'supposed' to be the same -o-same-o regardless of what state the Fed employee works. Just like everything else 'Federal', I guess, .
Also, what IS in writing cannot be deciphered .

Bookbear · Post by **Bookbear** » Mon Sep 11, 2006 3:20 pm

What??? You were expecting consistancy from the Federal Gummit? I'm shocked...shocked, I tell you, SHOCKED!

Offerocker · Post by **Offerocker** » Mon Sep 11, 2006 3:46 pm

BookBear: Yeah, I know!! And I should know better, because I worked for them for 21 years (of pure h-e-double-heck)...that's how I got to be in my present state!! My Book was going to be titled: "You wouldn't believe it!", but there was SO MUCH TO TELL!!! Well, it would have kept me well, as one of those 10-year joke calendars, ha ha.

trainhater · Post by **trainhater** » Mon Sep 11, 2006 4:13 pm

Thanks for all your responses, at least I have an Idea now. I hate having to call BCBS, most times I go through the prompts just to get transferred back to the original number I called.

I guess I should introduce myself, My Name is Tim, I am from Wisconsin, I also have High BP and ankylosing spondylitis, which pretty much keeps me in constant pain, and it has also attacked my thyroid. I used to take amitriptyline to to help sleep but the Sleep Doc just changed it to Trazodone. Between the BP pills, the Morphine, the anti-inflamatories, the synthroid and whatever else I am forgettting, my desk looks like a pharmacy. I have also had 2 back surgeries in less than a year and a half. The bad part is I am only 39.

Pretty bad when the people that work at the Wal-mart Pharamacy know you better than your neighbors. No worries though, the stress at work should kill me way before anything else does!

Thanks Again and take care,
Tim

krousseau · Post by **krousseau** » Mon Sep 11, 2006 4:41 pm

BC/BS Federal Employee Program benefits ID card says Government-Wide Service Benefit Program on it and has an outline of the US (minus Hawaii & Alaska-sorry to those who live there). The Website http://www.fepblue.org doesn't seem to do anything by state unless you are hunting for a provider-and I can hunt for one anywhere in the US.
There are some things that are I know are different-there may be others:
whether you have standard option or basic option; if you are choose a PPO or FFS, they also list an HMO option; there is a special enrollment group for postal workers-when I was working I liked doing discharge planning for the postal workers-they had the best benefits when it came to getting DME (except for service connected veterans with >50% disability); there may be some differences based on being a current employee or an annuitant; then there is Medicare + BC/BS FEP I haven't paid any out of pocket for DME since going on Medicare & BC/BS FEP unless it is something not considered medically necessary, like a hose cover.

krousseau · Post by **krousseau** » Mon Sep 11, 2006 4:56 pm

Some providers like labs doing sleep tests or blood work are not specifically contracted for as "preferred providers". The test just has to be ordered by a preferred provider. If a non-preferred provider orders something it can end up getting reimbursed at a lower rate. I went to a preferred hospital for a broken ankle-but the doc who saw me in the ER was not a preferred provider-fortunately he accepted payment by my insurance as payment in full. Similarly I has a procedure done by a preferred doc in a non preferred ambulatory surgery facility-and they accepted the insurance payment as payment in full. They could have billed me for $1400 more.
I think it is unreasonable to think patients in the emergency room are going to ask if the doc is a preferred provider. Or just before emergency surgery-checking to see if the anesthesiologist is preferred.

KansasRT · Post by **KansasRT** » Tue Sep 12, 2006 9:30 am

I have not seen an insurance plans that separate nasal masks and full face masks. BCBS in our area covers a new seal, tubing and filters every month, a new mask (it does not specify nasal or full face) every 3 months and new headgear every 6 months. I have heard that BCBS will cover masks more often with a script, but have never tried to challenge that. That being said, I also tell patients that the equipment is made to last longer than that. It is just important for them to keep it clean.

cwsanfor · Post by **cwsanfor** » Tue Sep 12, 2006 1:42 pm

Employees of the State of NC are insured by the State, but BC/BS is the claims processing contractor. I don't know whether that makes this post irrelevant, but they appear to have no limitation at all on masks (I'm sure if you abused this privelige they would somehow discourage you), and upon appeal, I convinced them to pay for the card reader and software. This is the best coverage I've seen.

I've thought about submitting a claim for masks I've bought on Yahoo, but I thought that would be pushing it. I don't know what their policy on new pressure transducers is.

Offerocker · Post by **Offerocker** » Tue Sep 12, 2006 9:36 pm

BC/BS has contracts with companies, or groups of employees. To generalize, State employees have a different contract than do Federal employees. I've found that the Federal Gov't has the worst contract w/BC/BS, and frankly the worst contracts in general, from my experience.

Sleepy-in-AL · Post by **Sleepy-in-AL** » Tue Sep 12, 2006 10:29 pm

Many of the BC/BS plans (most??) specify replacement supplies "as medically necessary." Now good luck finding a useful definition of what this really means.

According to my patient rep at BC/BS of Illinois, they want you to have a prescription for supplies, but won't commit to any timetable or definition of medical necessity. However, if your Dr. prescribes the supplies and you follow the Medicare time table or longer intervals they should have a hard time denying the claim.

Another point to consider is that many plans address supplies under the major medical portion of the plan which means that you may have to meet the major medical deductible before they will pay anything. The first year this shouldn't be a problem becuase the cpap/bipap will cost more than the deductible, but following years it may be more cost effective to purchase the supplies at cpap.com prices out of pocket.

Guest · Post by **Guest** » Wed Sep 13, 2006 8:06 am

KansasRT wrote:I have not seen an insurance plans that separate nasal masks and full face masks.

I asked the technician about this yesterday (to clarify if what I had been told by her manager) and she said that BCBS of MN only allows for mask replacement twice a year, which is what everyone else has. I told her what her manager had told me and she said that she must have mispoke. (??) Well, whatever. I certainly don't need that many mask replacements. Actually, I don't think I'd want that many either.... I mean, where would I put them??

Kimberly

Machine	Mask

Additional Comments: Avg. AHI .4

Mask

Mask

Additional Comments: Pressure MinE 11 MaxI 17.5

Anyone have Blue Cross Blue Shield for insurance?

Excellent coverage in NC