DME replacement schedule BCBS Excellus (NY)

Hello All,

I know this has come up before. I have done the search here and elsewhere.. But in 4 days of extreme googling, searching, I have yet to find a definitive replacement schedule.

Now I am pretty good at hunting down info, and I am a hospital insurance biller, and no, I have not called them yet because I am well aware of insurance companie's evasive practices. I will do that if I have to but I am trying to find the info in a softer, gentler way

I have worked with 3 dme companies in the 6 years we have tried to address my apnea. There have been some good individuals(I am trying to be nice) but overall, they seem handcuffed to say anything they can be held accountable to. Even my "off the record just a ballpark answer" question doesn't work. I suspect often the sleep technician is not the biller and so sleep technicians are basically not "allowed "to say much, and as a biller, I know how you have to be careful what you say to someone because the insurance deliberately deals in vaguities and will deny a claim unless they can't find any reason to deny it. Or won't answer direct questions.

I even have the added resource of being a provider biller and I can't find a definitive schedule. Nor can I find 'in print' that BCBS Excellus goes by Medicare schedules (altho I do know they do in many other cases) But I am looking fora sure fire "in print" schedule because I have already asked questions of my DME providers with litle success. One is giving me absolute incorrect info (and I don't mind gently educating them, but I have to know my stuff), one has revolving door apnea experts and I know how it takes real times to learn all the ins and outs of insurance behavior. And the third one had this huge selection of goodies, but every time I would make an appt, they would no show (with the office scratching their heads saying Golly Gosh, we don't know where she could be." Well, she wasn't there. Twice.

So, with all that, and possibly a smattering a frustration, can anyone here help me. I can't believe that all my specific google searches come up with nothing but a generic Excellus policy on DME's but not specfic and certainly not specific to sleep apnea devices.

This is incredible. There are so many of us and this can be a deadly disease, Jeezopete already!!!!!

PS. I think my crankiness is coming from the info I am learning here. The deliberate misguided advice from those in the business of allegedly provide health services to us.

lliann, Have you called and talked to CPAP Express? They are based in Rochester, NY. Got my equipment from them as I plan to retire to NYS in 20 months to be near family. They gave me a printout detailing replacement times: replace headgear every 6 mos. nasal pillows: 1 month. S9 Autoset H5i chamber: 6mos. hose: 6 mos. filters: each month. But from the Ins. no list. Perhaps they depend on the DME. At the time my insurer was BCBS and they didn't care if I bought equipment out of state. They paid their 70% no questions asked. Company I work for changed insurers... different story now.
Cannot speak highly enough of CPAP Express. Got great service and support. I was sad to be forced to drop them. But they will become my DME when I move back.
Hope this answers your questions.
Good luck with your search,
Cindy

Cindy Lou Who wrote:lliann, Have you called and talked to CPAP Express? They are based in Rochester, NY. Got my equipment from them as I plan to retire to NYS in 20 months to be near family. They gave me a printout detailing replacement times: replace headgear every 6 mos. nasal pillows: 1 month. S9 Autoset H5i chamber: 6mos. hose: 6 mos. filters: each month. But from the Ins. no list. Perhaps they depend on the DME. At the time my insurer was BCBS and they didn't care if I bought equipment out of state. They paid their 70% no questions asked. Company I work for changed insurers... different story now.
Cannot speak highly enough of CPAP Express. Got great service and support. I was sad to be forced to drop them. But they will become my DME when I move back.
Hope this answers your questions.
Good luck with your search,
Cindy

No I haven't but :zoom,: I'm on it....<g> Thank you soo much.

I will be retiring sometime between 2 to 14 months. Trying to get all this understood before I drop into the land of Medicare.

Ack, I am way upstate. Loved their supply picture tho. Thank you for the info.

Well, good luck anyway. It may be worth a call. Trying to remember the name of the gent that was office manager of the Henretta, NY office. He was a xpap user and full of info. Retired from Kodak.
Best wishes!
Cindy

Don't worry, it's a LOT easier to find the Medicare replacement schedule than your BCBS plan's!

Call Excellus and find out what's required to request the "Evidence of Coverage" book. This is the actual contract between you and your insurance company, even if you've never seen it before (and you haven't unless you specifically requested it). It's the real FINE PRINT of your relationship with your insurer, and the replacement schedule may be in there or it may be referenced so that you can know what to request from your insurer. Every state has different rules on what you need to do to get hold of this book. Usually you have to request it in writing, and your insurer must provide you with a hard copy within a certain number of days (in California, it's 10 days, I think).

You can also just ask your insurer--"I need a new mask cushion and it's been 3 months, is that covered?" Tell them you want a written reference because the DME is giving you grief.

Good luck!

If your current Blue Cross/BS is through work,
there may be a benefits manager in the personnel office.
Our guy is a bulldog, and his help in invaluable.
I used to have to sic him on United Healthcare a lot.

chunkyfrog wrote:If your current Blue Cross/BS is through work,
there may be a benefits manager in the personnel office.
Our guy is a bulldog, and his help in invaluable.
I used to have to sic him on United Healthcare a lot.

Hmmm, I'll start there and see where I end up. <g>

I have BCBS Excellus in NY (Utica area). I am not sure if the coverage differs with employers, but here is what mine covers:
-a new cushion once a month.
-a new mask and cushion every four months.
-a new hose every four months (could be three to be honest, I just go with four when I need it)
-filters once a month
Dependent on your machine, I can also get a replacement water tank for my humidifier every year as well. My DM provider was able to give me the exact info., luckily. The insurance company was not as well versed in this info. All the above were covered at 100% on my policy.
Sharon

Cindy Lou Who wrote:Well, good luck anyway. It may be worth a call. Trying to remember the name of the gent that was office manager of the Henretta, NY office. He was a xpap user and full of info. Retired from Kodak.
Best wishes!
Cindy

His first name was John but I can't remember his last name. I used to frequent the Henrietta store until my insurance changed.

I wonder if all of them work at different stores now that the Henrietta store is closed?

I have BCBS-Florida, I called them and they sent me a schedule in the mail. She told me it's the same as Medicare, FWIW. Dunno if that's true, or if it applies to your BCBS.

minniesc wrote:I have BCBS Excellus in NY (Utica area). I am not sure if the coverage differs with employers, but here is what mine covers:
-a new cushion once a month.
-a new mask and cushion every four months.
-a new hose every four months (could be three to be honest, I just go with four when I need it)
-filters once a month
Dependent on your machine, I can also get a replacement water tank for my humidifier every year as well. My DM provider was able to give me the exact info., luckily. The insurance company was not as well versed in this info. All the above were covered at 100% on my policy.
Sharon

Yep, thats is what I have. My ins company told me nothing. My DME is evasive. But I am persistant!!! Thank you for your help

In answer to C-Pap Xpress and Excellus insurance, I have many things to say.
1. CPAP equipment is ridiculously priced. At the cost of a high end Apple Mac laptop computer, a CPAP customer can receive a CPAP machine retail. Of course, CPAP machines are nowhere nearly as complex as an Mac Laptop.

2. The replacement supplies should not be as expensive as they are as the materials are fairly simple. But the CPAP manufacturers and CPAP vendors, such as CPAP Xpress, have upped the ante beyond reason.

3. The insurance companies then rebel by putting in more regulation (without notifying the customer), even for replacement supplies with the end result being that the customer has to make multiple trips to the vendor, now bring in the SD card to prove that you are using the machine, wait 24-72 hours for a response, and make a second, third or fourth trip to the vendor to get supplies.

4. Though not by actual collusion, CPAP vendors and manufacturers vs. the insurance companies have made the process so cumbersome that they have created the perfect storm of circumstances for someone to set up a black market for CPAP supplies.

5. Please tell me WHO but a CPAP user would NEED or WANT CPAP supplies?

6. WHY would anyone NOT using a CPAP machine even consider going to a CPAP vendor?

This is a two year old thread, yet the subject is, sadly, still true.
I would recommend replacing a DME at the first sign of inability or unwillingness to work for you.