How does your insurance bill your accessories and supplies

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Prettypistol
Posts: 18
Joined: Fri Mar 02, 2018 1:55 pm

Re: How does your insurance bill your accessories and supplies

Post by Prettypistol » Wed Mar 14, 2018 2:44 pm

Cardsfan wrote:
Wed Mar 14, 2018 9:56 am
So how were your supplies billed and coded? Do you think the codes are wrong? It would help if you post some actual details of what you believe is wrong with your EOB. I've been trying to follow your posts- so far, you state that the Ins. co should cover your cpap supplies at 100%. What are you being charged? The billing could be correct code wise, the problem could be what the ins. co believes your contribution should be- is that it?
I’m waiting on my eob to be mailed as I told you in the other post if you recall. All I can see is what is online. Once I have all the docs I need I’ll grab some screen shots for my original post and update.

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: How does your insurance bill your accessories and supplies

Post by Janknitz » Wed Mar 14, 2018 6:47 pm

1. What insurance do you have ? Group ..state etc..
No CPAP coverage under a Kaiser ACA plan

2. under what benefit do your supplies/accessories fall ? *example* are you paying your dme copay or deductable as if each supply (ex filter, mask, tube) should be subject to the same copay as your actual machine... ex. every time you get a mask your paying the same copay or deductable you would have on a machine
None. I buy my own, totally out of pocket but shop around to pay less than what my copays were back in the day when I had insurance in many cases. I like this better--no lying, cheating DME's and billing nightmares to deal with!

3. If you have your machine a year or longer are they billing supplies or accessories differently (ie you have proved complainace and whatever copay or deductable you have for a machine wouldn’t appply yearly since you already have the machine)
You should understand that most deductibles restart every year, either on the calendar year or the anniversary of your insurance contract. So if you got your machine anytime in 2017, you probably had to start a new deductible period January 1st 2018

4. Do you have any policy documents that SPECIFICALLY points to how accessories for a cpap machine should be billed ?
[/It sounds like you are having trouble with how the insurance company bills and pays for supplies. I'm going to let you in on a secret. This is all on a CONTRACT you have with your insurance company, but unless you have specifically asked to see it, you've never seen the contract you are bound to. It's called the Evidence of Coverage document ("EOC"). You need to request the EOC in writing and most states mandate that the insurer has so many days from the date of your request to provide it to you. So contact your insurance company and find out where to request the EOC in writing (occasionally you can access it online or have it emailed to you). That will tell you, SPECIFICALLY what supplies are covered, and what you need to do to get them covered. The EOC is magic because insurance companies sometimes lie. They tell you "X" isn't covered, or you can only get "Y" once a year. If the EOC says something else, then they MUST follow the EOC, no exceptions. The EOC will also explain how their deductibles and co-pays work. And most EOC's I've seen a in pretty plain English, so you can understand. Occasionally they obfuscate, but generally they are pretty clear. If you get your EOC and still have questions, post the relevant paragraphs and we can help you figure it out.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
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Prettypistol
Posts: 18
Joined: Fri Mar 02, 2018 1:55 pm

Re: How does your insurance bill your accessories and supplies

Post by Prettypistol » Thu Mar 15, 2018 2:52 pm

Janknitz wrote:
Wed Mar 14, 2018 6:47 pm
1. What insurance do you have ? Group ..state etc..
No CPAP coverage under a Kaiser ACA plan

2. under what benefit do your supplies/accessories fall ? *example* are you paying your dme copay or deductable as if each supply (ex filter, mask, tube) should be subject to the same copay as your actual machine... ex. every time you get a mask your paying the same copay or deductable you would have on a machine
None. I buy my own, totally out of pocket but shop around to pay less than what my copays were back in the day when I had insurance in many cases. I like this better--no lying, cheating DME's and billing nightmares to deal with!

3. If you have your machine a year or longer are they billing supplies or accessories differently (ie you have proved complainace and whatever copay or deductable you have for a machine wouldn’t appply yearly since you already have the machine)
You should understand that most deductibles restart every year, either on the calendar year or the anniversary of your insurance contract. So if you got your machine anytime in 2017, you probably had to start a new deductible period January 1st 2018

4. Do you have any policy documents that SPECIFICALLY points to how accessories for a cpap machine should be billed ?
[/It sounds like you are having trouble with how the insurance company bills and pays for supplies. I'm going to let you in on a secret. This is all on a CONTRACT you have with your insurance company, but unless you have specifically asked to see it, you've never seen the contract you are bound to. It's called the Evidence of Coverage document ("EOC"). You need to request the EOC in writing and most states mandate that the insurer has so many days from the date of your request to provide it to you. So contact your insurance company and find out where to request the EOC in writing (occasionally you can access it online or have it emailed to you). That will tell you, SPECIFICALLY what supplies are covered, and what you need to do to get them covered. The EOC is magic because insurance companies sometimes lie. They tell you "X" isn't covered, or you can only get "Y" once a year. If the EOC says something else, then they MUST follow the EOC, no exceptions. The EOC will also explain how their deductibles and co-pays work. And most EOC's I've seen a in pretty plain English, so you can understand. Occasionally they obfuscate, but generally they are pretty clear. If you get your EOC and still have questions, post the relevant paragraphs and we can help you figure it out.


I’m on it, thanks