Insurance refused on CPAP shipped to Canada: help please

Henry M. wrote:I think there are several very valid points but a few items that have not been mentioned. I know that when I purchased my CPAP device the homecare provider that I purchased through in Ontario spent several hours of their therapists time educating me on obstructive sleep apnea, fitting my mask, teaching me how to operate my CPAP machine, trouble shooting any problems I faced, downloaded my device information to send to the Dr. and even changing my prescription following a re-visit to a local sleep lab. I wonder if you purchase a unit from an internet provider or someone who is not local if you can expect to get this same kind of service. I am sure it is not cheap for these providers to staff their offices with trained healthcare professionals. I know since this is my health I would like to know that I am being looked after by a trained healthcare professional and realize that there is a cost for the excellent service I have received.

Hi, Henry.

I have no argument with what you've stated here, but if you do a little reading on this site, you'll find that your experience with your homecare provider is most definitely the exception, not the rule. It's unfortunate, of course, but that's how it is. Be grateful that you've gotten such good and thorough service, because most of us cannot say the same.

AMEN HENRY!!!

BleepingBeauty wrote:

Henry M. wrote:I think there are several very valid points but a few items that have not been mentioned. I know that when I purchased my CPAP device the homecare provider that I purchased through in Ontario spent several hours of their therapists time educating me on obstructive sleep apnea, fitting my mask, teaching me how to operate my CPAP machine, trouble shooting any problems I faced, downloaded my device information to send to the Dr. and even changing my prescription following a re-visit to a local sleep lab. I wonder if you purchase a unit from an internet provider or someone who is not local if you can expect to get this same kind of service. I am sure it is not cheap for these providers to staff their offices with trained healthcare professionals. I know since this is my health I would like to know that I am being looked after by a trained healthcare professional and realize that there is a cost for the excellent service I have received.

Hi, Henry.

I have no argument with what you've stated here, but if you do a little reading on this site, you'll find that your experience with your homecare provider is most definitely the exception, not the rule. It's unfortunate, of course, but that's how it is. Be grateful that you've gotten such good and thorough service, because most of us cannot say the same.

Yep, I for one did not have the same kind of service as Henry. In addition to the high cost of the equipment, they tacked on a couple hundred dollars for "time educating me on obstructive sleep apnea, fitting my mask, teaching me how to operate my CPAP machine, trouble shooting..." etc. That service was not freely included with my purchase. I paid big money for that, and I did not even need or use it. It would have been nice to have that choice especially since that money came straight out of my pocket.

Thank you all for the excellent feedback on this problem.

I thought I'd update this thread with the latest:

I ended up calling the union first to see what they'd have to say. Unfortunately, they were of no help as they would only arbitrate if it was a "systemic" problem (however they define that - I didn't ask). Since I was the first to bring this issue to their attention, they'd only keep a reference and contact me if further complaints arose. No help there.

I put my focus back to the insurance company. The first three calls were nearly identical: they'd only cover the 80% on equipment sourced in my province, not Canada wide or from the US. On the fourth attempt, however, I asked for the actual policy documents that spelled this limitation out. The rep said they couldn't provide that data because it would be multi-volume books in length. I asked for more than the vague summary available on their web site and was told a more detailed document wasn't available in any form. Asking to get bumped up the chain a few times, miraculously I was told that indeed, I could source the equipment Canada wide not just in my province. After being told the opposite five times previously (and specifically asked and verified each time), the rep only replied that this was "new" information he just found in my policy (of which, I can't get a copy).

Fully convinced now that these people were "making it up" as we went along, I asked for ANY documentation from this rep that was in any way specific. Again, miraculously, I was now told that my policy had a "US" clause in it and, pending approval of the specific equipment brand and type, I could source it from the US.

I immediately took his name and the time of call, asked him to make a note in the system of exactly what he just said, thanked him and politely hung up. I then went and ordered the IntelliPAP with humidifier and software, ResMed Swift LT and replacement filters from cpap.com. (Unfortunately someone from cpap.com called the next day and said they couldn't ship any ResMed products to Canada, but that's a whole different issue).

So. Moral of the story: If anyone on these boards from Canada ever has to deal with Pacific Blue Cross -- DON'T GIVE UP when they say "no". It seems the more persistent you are with this company the more your policy dynamically changes in your favor.

Again, thank you all for your ideas and help walking this path . I still haven't submitted my invoices to PBC as my equipment just arrived, but I'm almost positive I'll have it covered now for less than a third of the cost it would have been locally (for identical equipment, of course).

My best to you.
Michael

I deal with Pacific Blue Cross and a couple of years ago I submitted a bill from cpap.com without asking whether they would accept it. They did and I recovered my 80%

Recently I called to complain that I wanted to order a new mask from cpap.com that was significantly lower in price than those in BC and they didn't mention anything regarding US purchases but argued that I was not due for a mask and asked me to submit a prescription from my doctor and a quote from my BC supplier on cost.

I am not sure if they would only want the quote from them. I have told them that they should be happy to accept receipts from US suppliers because it would save them money but the clerks responding on the phone don't care what the company puts out apparently. They are simply trained to convince you that you don't need anything.

Keep us posted. Sad that it takes a fight to get anywhere.