BCBS replacement schedule

Hi,

I've been using an APAP for about 9 months now and I sleep much better and rarely nap any more.

I have Blue Cross Blue Shield (Fed Employee - Standard Option). Is BCBS's replacement schedule the same as Medicare?

I have a plan where I can use any provider but I have a $300 per person, $600 per family annual deductable including CPAP supplies. I'm planning on using cpap.com to order the supplies. If I used the DME, they'd soak BCBS for a $39 hose etc and I'd pay the whole thing due to the deductible. Is that correct?

I want to maximize the ordering of supplies so I can fully utilize the coverage.

Does anyone have any insight?

Thanks.

There are many different types of BCBS policies. I think most BCBS policies equal or exceed Medicare policies for replacement schedule.

I have BCBSGold. My DME was amazed at the frequency replacement my policy allowed. I had called BCBS ahead of time and found out exactly what equipment they would pay for and how often.

Check with BCBS to find out what your policy covers.

I do pay $$$$$ for my policy though. If employer offered a less policy with less premiums I would go for it.

Sleet wrote:Hi,

I've been using an APAP for about 9 months now and I sleep much better and rarely nap any more.

I have Blue Cross Blue Shield (Fed Employee - Standard Option). Is BCBS's replacement schedule the same as Medicare?

I have a plan where I can use any provider but I have a $300 per person, $600 per family annual deductable including CPAP supplies. I'm planning on using cpap.com to order the supplies. If I used the DME, they'd soak BCBS for a $39 hose etc and I'd pay the whole thing due to the deductible. Is that correct?

I want to maximize the ordering of supplies so I can fully utilize the coverage.

Does anyone have any insight?

Thanks.

Does your BCBS provider have a form (or some arrangement) that you can list your out-of-pocket expenses and get reimbursed for them (or get them applied to your deductible)?
Do you typically meet your deductible annually? If you don't, then you'd be better off purchasing your supplies from CPAP.COM or CPAPAUCTION.COM. (but keep track of your purchases)
Best case scenario.....you could keep track of your purchases and then turn them into your provider to either get them applied to your deductible and when that's met, your co-pay percentage would apply.

Den

I'm currently working in the Bahamas so I have to pay cash for everything medical and get reimbursed from BCBS so I'm used to the paperwork.

If I used a BCBS Preferred DME in the US and had them ship me the supplies, I'd have to pay for 15% of the costs once my deductible has been met.

if I used CPAP.com which is out of network, I'd have to pay 30% of the costs once my deductable is has been met .

I pay 100% of the costs until the decuctible is met.

I plan to get a lot of equipment through CPAP.com for the first $300 and send the bills to BCBS to count towards the deductible. Once the deductible is met, I plan to use the Preferred DME for anything else I'm entitled to and pay 15%. Even though the DME soaks BCBS, they'd have to come in at twice as much as CPAP.com in order for me to get hit any harder in the wallet.

If I can get enough equipment in 2009 and maintain it in good working order, I may not have to order nearly as much supplies next year.

I have a health care savings account that I can use to pay the deductible and copayments using pretax dollars as well.

Am I on the right track? Does anyone do anything similar?

Sounds like you're "doing the math" and have a plan.

Since I've never met my deductible (other than in 2005), I've purchased additional equipment and supplies out-of-pocket over the ensuing years, so I think I'm pretty well set for quite a few years. Sounds like you're thinking along the same lines.


Den

So the schedule appears to indicate that you can get 2 replacement nasal pillows every 30 days.

I wonder if the insurance company will fight me if I actually get that many.

I also get "two" replacement pillows every 30 days. I ordered 'two' from DME. Upon opening the shipment, there was 'one'. Each nare pillow counts as one. Go figure!

RachelM wrote:I also get "two" replacement pillows every 30 days. I ordered 'two' from DME. Upon opening the shipment, there was 'one'. Each nare pillow counts as one. Go figure!

Seriously? That sounds like a scam to me. I'd tell them if that is two, send me one. Will they cut it in half? I don't think they can charge two codes for one item that's fused together.

According to my insurance billing, they only charged BCBS for 'one'.

In my book, they should say that I can 'one' replacement per month and call it 'one' since that's what their 'two' means. Go figure!

You do realize that you are using 2 different deductibles, right? There is an in network one and an out of network one and paying on one doesn't add anything to the other one.

BeanMeScot wrote:You do realize that you are using 2 different deductibles, right? There is an in network one and an out of network one and paying on one doesn't add anything to the other one.

The plan literature doesn't say that. It says 300 per person, 600 per family. Are you sure the federal employee plan works that way?

Sleet wrote:

BeanMeScot wrote:You do realize that you are using 2 different deductibles, right? There is an in network one and an out of network one and paying on one doesn't add anything to the other one.

The plan literature doesn't say that. It says 300 per person, 600 per family. Are you sure the federal employee plan works that way?

You really should call your plan and ask them because these bcbs plans can be so diverse and complicated.

Sleet,

"Nobody/Guest" has a point. I have the Federal BCBS plan also and signed up for E-service through the FepBlue web site (http://www.fepblue.org). A separate login account is needed for each member on your plan (I have 3; myself, wife and daughter). Also have used the site to contact the appropriate BCBS sub-entity servicing your area, through e-mail, and have never had more than 48hrs pass before receiving an e-mail response.
The site is also great for tracking claims for the current year and two years previous.

Steve

I am about to get my first CPAP machine and have BCBS Federal employees standard option in Washington DC. I called them and they gave me a list of DMEs in the area. Do I have to buy or rent a machine through the DME to get reimbursement? Setting aside the deductible issue, what are the reimbursement rates for in-network DMEs and non-network suppliers like cpap.com? Do the DMEs allow me to choose what machine best meets my needs, even if it is more expensive? I have to travel overseas in my job.

I think that you will find that you are way ahead by just paying outright at cpap.com. The cpap will last many years. Masks and hoses also. Mine are all going on 7 years. Only reason to replace is to upgrade to smaller unit. My 420E works fine and i switch out between 2 masks that are 6 years old. The most important thing to remember is: BEWARE OF THE DME !

:twis ted: