Insurance Reimbursement with online retailer?

Have two questions related to insurance coverage.

I had CPAP.com get my prescription from my DME. I would like to order my replacement supplies from CPAP.com. I know CPAP.com does not handle insurance so I assume I would be able to submit a claim myself? If so, how is this done generally? I use BCBS of Texas for my insurance.

Second question is, what is the BCBS of Texas replacement schedule or where could I get it? This has to be documented somewhere...how does one get access to it?

Thanks a ton!

I had BCBS of Nebraska; My out of network deductible was double the in-network deductible.
I filed a claim, and it took them 5 months to apply my payment to the out of network deductible.
--because they "lost" it. Cpap.com was out of network for the plan I had.
Check with your individual plan if they even cover out of network--YMMV.
But BCBS are a miserable basket of reptiles--I'm glad to be rid of them.
For the following two years, I bought ALL my supplies from cpap.com.
BCBS sent me a letter, inquiring why I had not been buying from their pet DME.
I told them I saved money by going online.

cpap.com will send you an email with a universal insurance form you can print off and add your information for you to send it to your insurance company.
Now I don't know if your insurance company will reimburse you for what is likely considered an out of network supplier. You would need to check with your insurance company directly because it depends on your plan and there are lots of BCBS plans out there.

Regarding replacement schedule...again it depends on your plan and you would need to get that information from them.
Now if they tell you that they follow Medicare replacement guidelines (and a lot of insurance companies do) then you can see the Medicare replacement schedule here. It's last year's schedule but I don't think anything changed.
http://www.resmed.com/us/documents/1013 ... sories.pdf

Before I went on Medicare in late 2012 I was on a BC/BS PPO as my primary & only insuror.

Even though there was a separate out-of-network reimbursement %, they would NOT let the patient file a claim (just like Medicare). All claims had to be filed by the provider. And since CPAP.com does not file claims, my BC/BS PPO was useless there.

CPAP.com (or at least its owners) do operate brick & mortar DMEs in several locations in a handful of states that do accept insurance. You can go here https://www.hmssleep.com/main.php to see if there is one near you.
Click on "Contact Us" at the top right & it will take you to a list of locations by the states they serve.

I don't live near nor have I used any of their brick & mortar locations.
But, I am told by someone who has that all of the equipment & supplies bought from a brick & mortar location are shipped by CPAP.com to the location at which you placed your order & they then do their "DME" portion.
They will NOT ship directly to you.

And since their "DME" locations get just as bad reviews as most other DMEs, it seems (at least to me) that it is the "DME" model that does not work.
Putting another person or group of people in the mix seems to do nothing but create problems that would not exist if they were not in the mix.

The intelligent insurance company would at least cover consumables without a deductible or copay,
just to save themselves the expense of complications down the line.
Of course, insurance companies often assume if their service is bad enough (making sure it is),
that responsibility will fall to someone else.