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Online suppliers don't take insurance?
#1
Today I decided to buy the new Fisher & Paykel Pilairo mask. i called several of the suppliers in the Apnea Board supplier list, but none would take insurance. Is that true for all of them? If that's true it's kind of a pain, because local DMEs stock only half a dozen masks and won't special order.
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#2
From what I gather you have to pay in full upfront and than claim from your insurance. Some on online suppliers provide the forms but first check with with your insurance if they accept.
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#3
Hi JJJ, If I remember right, when I ordered from Supplier #1 in the supplier list on this board, they always sent me an insurance form in PDF to fill out if I wanted reimbursement. I'm not sure if all the suppliers do this or not. I know it gets to be a big pain in the butt at times.
trish6hundred
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#4
I'm sure some of them deal with insurance to a point. For example, Supplier #2 gives you all the codes and info you need to send to your insurance company for reimbursement, but I doubt any on-line companies would bill your insurance directly. It would be way too easy to commit insurance fraud on-line, at least I would think so.
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#5
Many insurance companies have an exclusive contract with one or two DME's, who offer them discounts.
Unless it is an essential item that the DME doesn't carry or can't get, the insurance company may not accept the mail order form. It's best to check with your insurance company BEFORE you buy, just to be sure they will cover your items.
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#6
Thanks for all the replies. I called a local DME that I have done business with in the past and they have the Pilairo on order. I know this DME will take my insurance, so that solves my current problem.

I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.
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#7
(07-18-2012, 10:33 AM)JJJ Wrote: Thanks for all the replies. I called a local DME that I have done business with in the past and they have the Pilairo on order. I know this DME will take my insurance, so that solves my current problem.

I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.

One major difference is that I do not need an RX for a BG meter or strips. I have had to make emergency purchases of these items when I boneheadedly left them at home and no one ever asked for an RX. My HMO goes by RX simply as a billing thing.

Masks and machines do require and RX.
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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#8
Some insurance won't pay for online purchases.

Some will reimburse as an "out of network" provider with a separate deductible and a higher copay.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#9
I've been having a running battle with both Medicare and the Blues because I used Supplier #1 to get my new CPAP and masks at a lower price than the insurance company's and Medicare's DMEs had the equipment. I figured that 75% of the cost for out-of-network purchases was more feasible than what my out-of-pocket costs would have been by using their DMEs. Of course right now I'm out the entire amount of the equipment. Hammer
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. 
ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINIONS ONLY AND NOT NECESSARILY STATEMENTS OF FACT.
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#10
(07-18-2012, 01:43 PM)mjbearit Wrote:
(07-18-2012, 10:33 AM)JJJ Wrote: I understand the potential for insurance fraud, but I might point out that there are several suppliers of diabetes products (mostly meters and test strips) that openly advertise for Medicare patients. If they can do it I should think that suppliers of CPAP equipment ought to be able to as well. I would bet that it would dramatically multiply their sales volume.
One major difference is that I do not need an RX for a BG meter or strips. I have had to make emergency purchases of these items when I boneheadedly left them at home and no one ever asked for an RX. My HMO goes by RX simply as a billing thing.Masks and machines do require an RX.

The diabetes suppliers make their business on the test strips for Medicare patients. Medicare will not reimburse them without a prescription from the doctor for the test strips.

I still submit that online suppliers are missing out on a huge amount of business by not taking insurance.
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