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                       INSURANCE COMPANIES AND SLEEP APNEA EQUIPMENT

I started my sleep apnea saga in November 2003.  I had the overnight test done and was diagnosed with severe apnea with 76 incidents per hour. I was assigned to a DME and given a straight pressure machine (CPAP) with a mask.. Luckily, I was poor so the state payed for everything. I started working in early 2004 and my insurance started in late Oct 2004. I started doing research about the new technology and found the remstar auto with c-flex that had software. I wanted a machine that gave me relief from the constant pressure and the software to monitor my condition. I called my sleep doc and told him my reasons for upgrading. He flatly disregarded my reasons and said no. I then went to my regular doctor armed with the info and he gladly wrote the prescription, noting that I was well informed, So far so good. I then called Blue Cross and spoke to someone about my intentions to buy my equipment online since it was 1/3rd the price. Was I covered? Yes, just submit the proper form and receipt and I would be re-emburshed. I got the full quote for what I wanted, called them again to confirm and get the proper form.  Once the equipment came, I submitted the info. I waited and waited and finally got a letter stating I had used the wrong form-the one they had sent me. I called and had the right form sent. I finally got a response-claim denied. Something about a waiting period for coverage to kick in. So naturally I filed an appeal stating that they had told me I was covered, that I went online to save us all money, that I could have waited the few months for coverage had I been told. To get a quicker response I faxed the appeal form. It was suppose top take a month. I called 3 weeks later and learned they had no record of the appeal. So I faxed again to the person I spoke to on phone. Called a few days later to confirm they had received it. Finally, after further review, they said they were mistaken and I got my refund. This took about 6 months.

Some actions I took proved very beneficial, particularly keeping good records of the experience.  Some things could have been done to make the process much quicker and simpler.  This has been quite a learning experience.  One thing I might also recommend is to be sure you are given information from your insurance company about the appeal process.  Here are my hints for buying equipment online or out of their system.

1)   Whenever you communicate with an insurance company keep a log. Time, date, subject, persons name you talked to, their phone ext etc.
2)   Make a list of your questions before you call. Make sure you cover all the bases. They keep phone logs of what is said.
3)   Work with the same person throughout process.
4)   Gets a written statement from them reviewing your eligibility, what they cover in system and out. your co-pays, what equipment they pay for etc. before you buy anything .
5)   Start a file and keep a copy everything you get in a safe place. EVERYTHING
6)   Make a copy of your prescription and put it in the file.
7)   When sending or faxing info, call them to confirm they have received it.
8)   Make sure you get the right re-imburshment form-this isn’t for regular medication. Make sure they know this.
9)   Encourage your insurance company to accept online purchases at the same re-imbursement rate as in system DMEs to save money.  They may not allow you the best in-network rates (payment/co-payment), but it is good to complain and encourage them to do so.  It might be worth the effort to make that recommendation in the hopes that one day the insurance companies accept online suppliers as in-network providers.


Loonlvr