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Excellus Insurance
#1
First of all, I am newly diagnosed and just beginning to find my way through all of this so hello to everyone here! With that said, if I do something wrong with my posting please let me know ..... this is my first post.

Yesterday I went to my DME for a download and report for an upcoming doctor visit on Monday. The first thing I noticed was a sign on the counter about Excellus insurance (attached). I am in central NY and I have Excellus. When I inquired further, I was told that this applied to EVERYTHING.... even filters, etc.

In addition, the DME informed me that Excellus was not requiring them to submit new compliance downloads every 6 months and that they were the only company doing this.

I am still documenting my first month (which is at 100%) and I am doing well thus far. I can certainly understand the desire for insurance companies to know that the equipment they payed for is being used but at some point it becomes ridiculous. Once they have payed for the machine, such a demand appears intrusive and unnecessary (except for the continued cost of masks, etc.) This policy seems like way too much "big brother" for me.

Is anyone else dealing with this issue? Is it only Excellus? How much of this is the DME interpretation of Excellus requirements? I am so sick of insurance companies making life more difficult.

Sorry for the long post.


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#2
Hehe - Well, after all my years with the same sleep Doc, when I got on Medicare, I had to downgrade from a Bilevel to a CPAP because I was never titrated for a bilevel, it wass only the Doc's notes (years ago) that put me on my VPAP. I need a new sleep study to get a new bilevel.

So, welcome to the crap - beats paying cash though!
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#3
Hi troykajoe,
WELCOME! to the forum.!
I have never heard of Excellus insurance, but there are lots of insurance programs out there.
Just keep on documenting your progress, great to hear you are doing well with CPAP so far..
Hang in there for more suggestions and best of luck to you with your CPAP therapy.
trish6hundred
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#4
Excellus is actually "Excellus Blue Cross/Blue Shield". It is just a local version of BCBS that is sold to providers in this area.

From what I can determine, they are putting together "custom packages" for employers. This is a problem because if one person's Excellus is from a different employer than anothers, the specific details of their coverage may be different even though they both have the same name insurance.

I was just curious of anyone else was having the same problem. So far it doesn't seem like it.

(09-06-2014, 12:11 PM)trish6hundred Wrote: Hi troykajoe,
WELCOME! to the forum.!
I have never heard of Excellus insurance, but there are lots of insurance programs out there.
Just keep on documenting your progress, great to hear you are doing well with CPAP so far..
Hang in there for more suggestions and best of luck to you with your CPAP therapy.

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#5
Not exactly the same.
My PCP must submit a request for authorization to his medical group. I requested supplies 3 weeks ago. Yesterday the girl who does the request informed me she lost my list and has not yet submitted my request. Then the approve or disapprove the request and inform the PCP office and the vendor or specialist. My PCP then informs me of the approval. Then I wait for the vendor (Crapria) to fill my order. If I am very lucky every one in the chain understood what I wanted and fills the order correctly. In June it only took 4 tries to get all 5 items correct.
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#6
I don't have the same insurance but understand the big brother thing!

Right now I am stock piling all the supplies that are available to me before I have to go on Medicare. Every month new pillows. Every 6 months a new mask. Tubbing on schedule...you get the drift.
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#7
I think most insurance companies have a policy where things are supposed to be pre-authorized, but they tend not to be too finicky about it when it comes to CPAP stuff and DMEs sending in invoices.

Sounds like Excellus has put their foot down and are demanding everyone follow their rules.

I think either a) Excellus will get a bunch of folks jumping ship or complaints and realize that they are in the minority....resulting in a relaxation of the policy again or b) a bunch of other insurance companies will follow suit in the near future.

Hopefully it'll be the former and not the latter.
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#8
I think your analysis is correct and I certainly hope they see the error of their ways. I just noticed that I typed incorrectly in the original post.... Excellus BCBS IS now requiring compliance data every 6 months.

How many people on here have to do repeat compliance data after the original 30/90 days?
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#9
(09-10-2014, 08:21 PM)troykajoe Wrote: I think your analysis is correct and I certainly hope they see the error of their ways. I just noticed that I typed incorrectly in the original post.... Excellus BCBS IS now requiring compliance data every 6 months.

How many people on here have to do repeat compliance data after the original 30/90 days?

I have to show compliance for 11 months and can't get any new supplies paid for through the insurance company for 9 months. I'm four months in to this process and looking forward to the day I finally complete this process.
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#10
I have zero compliance requirement, even though I have been 100% compliant.
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