Blue Cross-Blue Shield and Cpap

Can anyone tell me how well Blue Cross-Blue Shield insurance pays on Cpap equipment? Mine is out of Texas and I was just wondering if someone else out there with the same insurance has used it for their Cpap needs. Thanks

Bearcat42 wrote:Can anyone tell me how well Blue Cross-Blue Shield insurance pays on Cpap equipment? Mine is out of Texas and I was just wondering if someone else out there with the same insurance has used it for their Cpap needs. Thanks

Do you have a out of pocket deductible? My Blue Cross deductible is 750 out of pocket for the year and than 20% co pay until 2,000 dollars. The 750 deductible was applied to my sleep study.

Sleep study - 2,500 - insurance paid 1,640 - I paid 860.00

Equipment - 3,551.50 - insurance paid 3,192.30 - I paid 358.80

I have BCBS with a PPO. I had different insurance when I did my sleep study. They rent the machine and I am charged $62 a month for it which is going to my deductible right now.

I have Anthem Blue Cross here in Connecticut. I paid a $10 co-pay for my initial appointment with the sleep doctore. Other than that, I have not paid a dime for anything, including either of the two sleep studies, the cpap machine, or mask. The DME told me I have excellent insurance, which I already knew. I will not be changing insurance anytime soon.

FWIIW, I believe there are many types of BC BS, ansd what you pay will depend on the type

Ya, there's many different BCBS plans....

I have the State of Kansas Employee Plan A. My in-network is $50 deductible and 20% co-insurance ($1100 co-insurance maximum). DME is limited to $5000 per year (plus various other rules)....

The Dreamer.

Just noticed that it says only the very basic of equipment is covered....wonder if it said that last year.... Though I'm sure the prescription said data capable, so guess I got that...

I have Anthem (Blue Cross) of California, Classic HMO. I paid nothing for the sleep studies, 20% of my DME (Durable Medical Equipment) costs and a $20 co-pay when I actually saw the doctor.

My machine ended up costing me $168 and change.

As has been pointed out, there are many "flavors" of BCBS. Mine is written by BCBS of Florida and is for Federal employees.

I pay $25 co-pay for a GP, $30 for a specialist.

I pay the DME 23.46/mo for my machine (BC pays $54.74/mo), and $2.25 for a 2-pack of fine filters (BC $17.75).

Isnt it funny how there are so many different variences, even within BCBS? I did not realize that it changed so much depending on what state you are in or which one you have.

My husband was charged 3000.00 for a CPAP Test and has to pay 500.00 of it BCBS FED. He was required to take the test to get a new mask. He has been on the machine for 16 years. No prescription would be written without the test. This is fraud and I'm angry as hell. We already have med bills coming out the gazzo because he has had three strokes. Know one will cover him for additional ins because of the strokes. How can they withhold the prescription?

BCBS makes unique agreements with each and every company/govt. entity with which they have contracts.
If there are a thousand clients (companies, etc.), there are probably a thousand different contracts--
each of which may have a different combination of premiums, benefits, deductibles, and co-pays.
The OP's question is impossible to answer, except by BCBS personnel.

jrandyswanson wrote:...... This is fraud and I'm angry as hell. We already have med bills coming out the gazzo because he has had three strokes. ..

Why is it fraud for insurance or a DME to ask for a prescription? How long has it been since he saw the sleep doctor or had a sleep test? Things may have changed because of the strokes. I'm sorry for his poor health and your bills.

jrandyswanson wrote:My husband was charged 3000.00 for a CPAP Test and has to pay 500.00 of it BCBS FED. He was required to take the test to get a new mask. He has been on the machine for 16 years. No prescription would be written without the test. This is fraud and I'm angry as hell. We already have med bills coming out the gazzo because he has had three strokes. Know one will cover him for additional ins because of the strokes. How can they withhold the prescription?

Doctors will not write a prescription without a lab study. The prescription has to include the pressure settings. The doctor does not know the appropriate pressure settings without a lab study which determines them.

If your husband's last lab test was a long time ago the pressure settings may have changed.

If you had asked here first I am sure someone would have told you how to get a mask without a prescription. (I don't think I was required to show a prescription when I bought my last mask.) But you need a prescription to buy a new machine.

To jrandyswanson:
The requirement for a prescription is usually to ensure the patient is receiving the appropriate care for current conditions.
It sounds like a doctor is needed. Make an appointment and get this done. Your copay is not unusually high--many are higher.
This is for his health--anything is better than the alternative.
Do what you need to do for his health. This is what we all do here.

Bearcat42 wrote:Isnt it funny how there are so many different variences, even within BCBS? I did not realize that it changed so much depending on what state you are in or which one you have.

The best way to think of BCBS in the modern era is as a kind of franchise operation. The Blue Cross Blue Shield Association, which has its headquarters in the building where I work, doesn't sell insurance itself, but owns the trademarks and licenses several dozen independent companies around the country to market their products under the BCBS name in various territories. Illinois, New Mexico, Oklahoma, and Texas are all operated by an outfit called Health Care Service Corporation. So not only does each BCBS operator offer many different plans with subtle differences, but there are many completely different companies using the name.