Blue Cross and Health Care Coverage

Can anyone tell me why neither my provincial medical plan nor Blue Cross will cover the cost of a CPAP machine? I have had an assessment and my heart surgeon will not go ahead with further surgery until I have used a CPAP machine for one month. The cost of the machine ( as I'm sure you all know) is high for a pensioner. I can't understand why there is no coverage since it seems to me that my ability to breath is an important as my heart function which is covered under my medical plan and blue cross? Any ideas?

The great majority of BCBS policies do cover cpap. When I read your post, I thought you might be Canadian. If so, I am no expert on the situation there.

I suggest you find out why each insurance is denying coverage, as it could be due to some factor that can be easily corrected. In the USA, rental cpaps are widely available. Have you had a sleep study? If so, what were the results?

In the USA, rental cpaps are widely available.

It probably has to do with your coverage, or the plan you have. Bot every plan covers every type of medical need. Cpaps fall under a category called Durable Medical Equipment. Either your plan does not cover DME or you did not meet the requirements that the insurance demands in order to approve use of a cpap. This is easily found by calling the 800# on the back of your credit card and asking if you have DME coverage and if yes what exact requirment do you have to meet to get a cpap.

Dan

I have BCBS and have been on CPAP for 7 yrs, they cover all of my needs for the CPAP, be it a hose or mask...you should check with your provider on the phone, and if you are in the US and on retirement, look into medicare or medicaid, they do cover these items.

Good Luck, and sleep tight!
Apnatic

Thanks for the replies to my question about coverage. The answer, unfortunately remains no. However, I was able to purchase a machine at a different location than the one my doctor sent the prescription to (not without his objections) and saved over 30% on the same machine (model, manufacturer, mask, et cetera) so there must be a substantial mark up on the items. It is helping my sleep although it does increase the number of heart problems and visits to the hospital. Anyone else had the same experience and have any solutions to investigate. Thanks again. Chris.

If you haven't checked with your BCBS administrator at work do so. If you are not satisfied with their answer call BCBS yourself.

Under BCBS they require a sleep lab test first before they will allow our doctor to write a prescription for a CPAP machine.

You just need to find out the "angles" of your program.

I can't believe they won't cover you for at least one month.