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Switching Insurance = New Machine?
I recently switched insurance plans from Aetna to Blue Cross. My durable medical equipment provider is saying that even though i've had my existing machine for less than 5 years, that I'm automatically eligible for a spanking new machine just because of the switch in insurance companies. Is that true?
Views: 49
Replies to This Discussion
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Permalink Reply by Judy on
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My guess is YES! And since your DME is saying it is so, its their responsibility to ensure that they will be reimbursed by your insurance. If it turns out not, return it as it was offered to you under false pretenses.
Be sure this time to get the exact fully data capable APAP you want. Brand and model. Keep the old one as a travel and backup device.
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Permalink Reply by Daniel on
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Seconded. There may be a requirement for a fresh prescription from your doctor, but if so, that usually isn't a problem. Consider this to be one of the few positive aspects of switching insurance companies. Of course, be careful in terms of your deductible/co-insurance. These days, when a company switches policies, it is seldom to get better coverage, but rather to save some money. This often means that the new coverage is worse than the prior. If you have a high deductible policy, you could wind up paying $2000 for a CPAP you don't really need.
Daniel
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Whew! Thanks, Daniel Levy. I forgot about those annual deductibles!!
PDLaire, call your new insurance company and ask what your DME benefits are: limits, copays, deductible, etc.
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Permalink Reply by PD Laire on
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i've met the deductible. what's the best ResMed auto-adjusting CPAP on the market?
Judy said:Whew! Thanks, Daniel Levy. I forgot about those annual deductibles!!
PDLaire, call your new insurance company and ask what your DME benefits are: limits, copays, deductible, etc.
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Thanks. I'm going to get the ResMed S9 AutoSet II with EPR based on your advice. Now I just have to wait a week or two while my doctor mails the equipment provider my prescription. if i only had kept a copy from the beginning...
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Permalink Reply by Dan Lyons on
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Correct the issue of not having a copy now. Just tell the doctor you will stop by and pick it up, then make a copy before going to the DME.
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Its not too late. Ask your sleep lab or doctor for a copy of the doctor's dictated results (1-2 pages each), full scored data summary report w/condensed graphs (5+ pages each) for both your sleep evaluation study AND your titration study AS WELL AS a copy of your equipment order (script). They are part of your medical records and as such you have a LEGAL RIGHT to copies of them under HIPAA assuming you are in the USA.
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I want a ResMed over a Respironics, but is there another auto-adjusting CPAP machine that's even better than the top ones put out by these manufacturers? I'm flexible.
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I don't know that there are any that are better but in the Articles section of this forum there is a list of all fully data capable APAPs and there is a link to a comparison between the new DeVilBiss APAP and the Respironics M Series APAP w/A-Flex by those who had the opportunity to use both and their reasons for the one they chose as the best for them.
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