New Insurance - Help!

[cpapjack]

I have new insurance as of January 6th this year. I am in need of a new BiPap machine, and my insurance, BCBS of SC, is telling me before they can authorize the rental/purchase of a new machine, I need to have another sleep study done. My last one was 7years ago. Well, the problem with that is, with my insurance plan, I have to pay the first $3,000, which there is no way I can afford that.

How can I convince the insurance company to authorize a new BiPap without a new sleep study? I manage my own therapy, thanks to everyone here, and have had an AHI of less than 2 every night for the past 7 years.

[LSAT]

I have new insurance as of January 6th this year. I am in need of a new BiPap machine, and my insurance, BCBS of SC, is telling me before they can authorize the rental/purchase of a new machine, I need to have another sleep study done. My last one was 7years ago. Well, the problem with that is, with my insurance plan, I have to pay the first $3,000, which there is no way I can afford that.

How can I convince the insurance company to authorize a new BiPap without a new sleep study? I manage my own therapy, thanks to everyone here, and have had an AHI of less than 2 every night for the past 7 years.

I don't think you can if that's their rule.

[STL Mark]

Even if they waived it the first $3000 of the cost of the machine would be your responsibility. It sounds like a better plan may be desirable for next year. In the mean time, I would look for a new or gently used machine from places like our sponsor or secondwindcpap.

[StuUnderPressure]

If you are already on a BiPap now, I think that requiring a new Sleep Study is just a waste of YOUR time & YOUR money.

If you are trying to switch to a BiPap, then another Sleep Study is usually required.

But, remember that even if the insurance company would not be requiring another Sleep Study, you will still have to pay 100% of the cost of the BiPap until you meet your deductible under this new insurance.

Even Medicare does NOT require a new Sleep Study IF your previous Sleep Study meets the CURRENT requirements of Medicare.
Most previous Sleep Studies WILL meet the current Medicare requirements unless your previous Sleep Study was done in a cave by a caveman.

I am told by my Sleep Doctor that my 16 year old Sleep Study WOULD meet the current Medicare requirements. And unless those Medicare requirements change, I hope to not have another Sleep Study done when I replace my current APAP in approx 3 years.

[cpapjack]

If you are already on a BiPap now, I think that requiring a new Sleep Study is just a waste of YOUR time & YOUR money.

If you are trying to switch to a BiPap, then another Sleep Study is usually required.

But, remember that even if the insurance company would not be requiring another Sleep Study, you will still have to pay 100% of the cost of the BiPap until you meet your deductible under this new insurance.

Even Medicare does NOT require a new Sleep Study IF your previous Sleep Study meets the CURRENT requirements of Medicare.
Most previous Sleep Studies WILL meet the current Medicare requirements unless your previous Sleep Study was done in a cave by a caveman.

I am told by my Sleep Doctor that my 16 year old Sleep Study WOULD meet the current Medicare requirements. And unless those Medicare requirements change, I hope to not have another Sleep Study done when I replace my current APAP in approx 3 years.

Yep. I'm already on a BiPap. My last sleep study was because my insurance at the time required it to go from a CPAP to the BiPap. (I had 100% DME coverage)

My DME said that she has other patients who have BCBS and gotten a new BiPap with an older sleep study than mine.

I called the insurance company and left a message for the lady who denied this request. Hopefully she can provide more clarification why they denied it. My primary dr. is willing to write my script however need be, so I'm hoping that's all it takes.

As far as being responsible for the 100% of the cost before coverage kicks in, I made sure to budget for it this year.

[sawinglogz]

I'm glad you've already called to inquire. Have you had any lapse in insurance coverage before moving to your new provider? Usually if you've got any efficacy or compliance data and you're already on a machine, they'll keep you on therapy.

Given that there's no clinical evidence that people are spontaneously cured, it seems a little odd that they would recommend a test essentially for that. Normally the rules are based on clinical studies.

Keep escalating and appealing. How old is your current machine?

[CPAPbuyer]

New machine? or new script? If your AHI is < 2....your machine is working fine. Whats the exact issue for needing "new"?


I can help you source a replacement machine much cheaper than most of these websites, and alot cheaper then your $3000.00 deductible....

[chunkyfrog]

I bought my second and third machines brand new from our hosts, cpap.com.
Had I been stingier, I would have opted for a gently used or open box model from secondwindcpap.com
Local DME's have "higher overhead", (or so they say)--prices are way cheaper online.