CPAP and BCBS

Sport · Post by **Sport** » Sun Jan 17, 2010 6:45 pm

Is anyone familiar with BCBS preferred provider with DME. I was following Dr's referral, now to find that the machine i got 3 days ago from the referred supplier is costing much more than I found through other DME suppliers. My out of pocket is 30% so I am paying about 220 more than I need to based on what I am see online. I read a post that BCBS won't accept cpap com as a supplier - not in network. Anybody have experience around this. thanks.

jules · Post by **jules** » Sun Jan 17, 2010 6:55 pm

each policy is different and you need to contact people in charge of your program - is there a card with a number or a pamphlet with a list of places you can call? You want to know about Durable Medical Equipment benefits for your particular plan.

angela6 · Post by **angela6** » Sun Jan 17, 2010 7:00 pm

I live in central Maryland and have a form of BCBS called CareFirst. They only accept people in network and only cover a certain percentage of costs. They will not pay any benefits for any DME out of network. Cpapdotcom was not in network.

I contacted several DME's in my geographic area and the ones in network were charging a lot more than the prices on cpapdotcom. The brick and mortar DME's only carried certain brands and certain models. After doing more research I decided to get my cpap thru our host and I definitely paid less. I was also able to choose from a wide variety of manufacturers and models. I was pleased with the customer service and could try different masks by purchasing mask insurance.

Just one opinion.

Sport · Post by **Sport** » Sun Jan 17, 2010 7:07 pm

Thanks a bunch. Please share more. I am live in Maryland near Frederick. Used outfit in Glen Burnie called Sleep Services of America. I also have Carefirst BCBS Basic through federal program. Are you saying that you blew of the insurance and bought it yourself through cpapdotcom. Thanks again. I am trying to find a list of in network providers. Guess I can call BCBS tomorrow.

Muse-Inc · Post by **Muse-Inc** » Sun Jan 17, 2010 7:21 pm

BCBS of Georiga: my 20% copay was $890 for a CPAP I could have bought for about $300-350 at the time...and it was a no-data CPAP at that! I was clueless. Insurance refused my doc's medically necessary request to upgrade my machine to an APAP...their doc reviewed the request and said it wasn't a medical necessity (he rejects, er, ah, he reviews, hundreds of requests a day, how much time did my request get?). Appealing was a complete waste of time and effort...medical rationing at its finest.

Much easier to just buy your stuff from our host, they're great to deal with.

bailachel · Post by **bailachel** » Sun Jan 17, 2010 7:33 pm

Since BCBS has many types/levels of plans, that may impact your ability to use non-network providers. BTW, I have BCBS/Carefirst - Maryland. I paid 20% co-pay ($120) of $600 billed by my brick and mortar DME for my machine.

RipVW · Post by **RipVW** » Sun Jan 17, 2010 7:38 pm

My BSBS paid the full price for my first machine (ResMed Elite), but after I found this forum, decided I wanted an APAP, so I got it from cpap.com, paid out of pocket. It was worth it for me!

Wulfman · Post by **Wulfman** » Sun Jan 17, 2010 10:34 pm

Sport wrote:Is anyone familiar with BCBS preferred provider with DME. I was following Dr's referral, now to find that the machine i got 3 days ago from the referred supplier is costing much more than I found through other DME suppliers. My out of pocket is 30% so I am paying about 220 more than I need to based on what I am see online. I read a post that BCBS won't accept cpap com as a supplier - not in network. Anybody have experience around this. thanks.

It was reported in prior years that BCBS (some groups) would reimburse their members for out-of-pocket purchases.....some at 100%. It would be a rare insurance provider that would reimburse an online provider for the equipment.......to them, they would be out-of-network. HOWEVER......if the insurance provider will reimburse YOU (if they consider their members to be in-network), for the purchase at the in-network rate, then what you would do is to first ASK THEM.......then if they will, you would purchase the equipment from the online seller on your credit card.......then submit an invoice to your insurance provider with you as the billing party and them as the party being billed.

That's what I did with my insurance provider (a self-insurance PPO) about 5 years ago.......but they're not BCBS.
But, I was also prepared to purchase EVERYTHING out of pocket (if they had not agreed to do that) rather than purchase from a local DME. I "did the math" and would have come out better by any other way than going through the local DMEs. Anyway I got reimbursed for 80% of my online equipment purchase.

Den

angela 6 · Post by **angela 6** » Sun Jan 17, 2010 11:03 pm

Sport:

I too live in the Frederick area. I looked up the DME's considered in network off the CareFirst BCBS website. I have a PPO and there are also HMO's so provider lists could be different. I contacted several DME's in Frederick: the one affiliated with the hospital, Gamma and one other in Frederick (the name is escaping me at the moment). All three were polite, Gamma offered to come to my home to set up machine. But after finding out that each DME only offered some models of one manufacturer,and two of the DME's would only offer cpaps on a rental plan, and the prices seemed high to me, I decided to look into cpapdotcom.

Now, I am using cpap for about 8 months now and consider myself a newbie. I was willing to do my research, I wanted to purchase and machine outright, and I wanted an auto machine. I decided to use cpapdotcom. I was also willing to learn how to use a mask and machine on my own without any help. I did try the first mask and wound up happy with the second choice of masks. I read a lot on this forum, posted questions when I didn't understand things, and learned a lot about my therapy.

There are benefits to using a good brick and mortar DME and there are benefits to using online cpap companies. Why don't you look at the BCBS website for the list of providers for your insurance plan, make some calls to at least three different ones, and also check out online providers.

Good luck.

Angela 6

angela6 · Post by **angela6** » Sun Jan 17, 2010 11:08 pm

angela 6 wrote:Sport:

I too live in the Frederick area. I looked up the DME's considered in network off the CareFirst BCBS website. I have a PPO and there are also HMO's so provider lists could be different. I contacted several DME's in Frederick: the one affiliated with the hospital, Gamma and one other in Frederick (the name is escaping me at the moment). All three were polite, Gamma offered to come to my home to set up machine. But after finding out that each DME only offered some models of one manufacturer,and two of the DME's would only offer cpaps on a rental plan, and the prices seemed high to me, I decided to look into cpapdotcom.

Now, I am using cpap for about 8 months now and consider myself a newbie. I was willing to do research, I wanted to purchase a machine outright, and I wanted an auto machine. I decided to use cpapdotcom. I was also willing to learn how to use a mask and machine on my own without any help. I did try the first mask and wound up happy with the second choice of masks. I read a lot on this forum, posted questions when I didn't understand things, and learned a lot about my therapy.

There are benefits to using a good brick and mortar DME and there are benefits to using online cpap companies. Why don't you look at the BCBS website for the list of providers for your insurance plan, make some calls to at least three different ones, and also check out online providers.

Good luck.

Angela 6

MarylandCPAPer · Post by **MarylandCPAPer** » Mon Jan 18, 2010 12:39 am

I am in Baltimore Maryland, was just prescribed CPAP treatment last month, and got my CPAP equipment before the end of the year through Bay State Medical Equipment, which is in Hanover, MD near Arundel Mills Mall and is an in-network DME provider with Carefirst. So far, I have been very pleased with the service I have gotten and the equipment was covered by my Carefirst plan.

Patrick A · Post by **Patrick A** » Mon Jan 18, 2010 12:54 am

Sport wrote:Is anyone familiar with BCBS preferred provider with DME. I was following Dr's referral, now to find that the machine i got 3 days ago from the referred supplier is costing much more than I found through other DME suppliers. My out of pocket is 30% so I am paying about 220 more than I need to based on what I am see online. I read a post that BCBS won't accept cpap com as a supplier - not in network. Anybody have experience around this. thanks.

I have BC/BS FEHB....when I went on cpap I was not on Social Security. I am now on Medicare as my primary and BC/BS as my secondary. When I got my first machine my co-pay was $10.50 a month for 13 months. BC/BS paid $105.00 a month to Apria ripoff. Yhey are a preferred provider DME for BC/BS FEHB(I don't like them). I just got a new machine an M-Series Bi-Pap Auto from a different DME Advanced Home Care.(I think they are an out of network provider for BC/BS but a provider for Medicare) Go figure. They gave me some paperwork that stated I would have to pay at total of $330.00 over a period of 13 months. That was what I would pay after Medicare paid for the machine. I talked to BC/BS FEHB and they said that they would pay what ever Medicare did not pay.

Amontilado · Post by **Amontilado** » Mon Jan 18, 2010 3:55 am

If you have BCBS through the the Federal Employee Program, go to http://www.fepblue.org. It will spell out what providers are in network and such. Also, the Federal BCBS benefits are consistent throughout the country, just administered by different baby blues. Call/write your BCBS provider and ask.

Steve

VA-APAP · Post by **VA-APAP** » Wed Sep 29, 2010 5:07 pm

From the advice of this board, I contacted Bay State Medical to get my CPAP (after of course going through the normal process of getting a sleep study). In my case, Carefirst covered 100% of the costs of my CPAP.

To get the device, Bay State Medical wanted me to fax my sleep study (I had the Fairfax Sleep Disorder Center fax it to them directly - they did my sleep study), a copy of my insurance card, and a copy of my prescription for the CPAP from my doctor.

A technician came out to my house and showed me the machine and how to use it and how to clean it. He was great.

I got the standard machine they offer which is the PR SystemOne - an APAP machine with a heated humidifier.

Overall, I'm very satisfied. I faxed in the materials on a Monday, and Bay State Medical called me back that day to schedule an appointment. The technician came to my house on Wednesday (there just happened to an opening two days after I faxed in the materials).

LoQ · Post by **LoQ** » Wed Sep 29, 2010 7:36 pm

Sport wrote:Is anyone familiar with BCBS preferred provider with DME. I was following Dr's referral, now to find that the machine i got 3 days ago from the referred supplier is costing much more than I found through other DME suppliers. My out of pocket is 30% so I am paying about 220 more than I need to based on what I am see online. I read a post that BCBS won't accept cpap com as a supplier - not in network. Anybody have experience around this. thanks.

Each BCBS program may be different, so keep that in mind. I have BCBS, and what they told me was that I could not get re-imbursed for purchases from cpap.com. However, if I happened to be out of network and needed equipment, then I could use someone local and be reimbursed on the out of network schedule. It makes sense to me that next time I'm in Texas, I might just have a need for some more equipment. Heh.

Also, I'm not entirely comfortable that the representatives I talk to on the phone really know the answers. I believe they try really hard to get it right, but some of them seem less than certain about what they tell me.

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