BCBS Reimbursement for Lofta after the fact

[KonradVH]

I was desperate for sleep and getting into a sleep specialist, much less actually receiving a CPAP, was going to take weeks. I opted to go through Lofta and went from an AHI of 56.7 to less than 1 within 2 weeks. I realize that all these costs will likely not be covered but Lofta said they can send me everything needed to file: sleep study results, diagnosis, itemized purchases, and 90-day compliance report.

I'm pretty sure BCBS will tell me no but I wanted to see if anyone has been successful in at least getting it applied to their out-of-network deductible?

[Jay51]

I was in a similar situation.  I first took the Lofta home sleep study (paid for it out of pocket).  Lofta is a DME.  After I got my results from them, a representative from Lofta also encouraged me to purchase a specific machine - she said my insurance would likely cover it.  I have BCBS also (HMO).   IMO they have been fantastic for me.

I decided not to go with Lofta, but instead went to my PCP and got a polysomnography from my insurance.  After that, pretty much anything my PCP or Pulmonologist wanted from my insurance, I got.  Same with my Cardiologsist. (also ENT, Allergist, etc.).  

I know the name of the Sleep Dr. who provided your test.  It may depend on his credentials as to how much compensation you receive.  My suggestion would:  if somehow you could get you PCP, or other Dr. (even a Dentist can write a prescription for a xpap machine) involved, then the insurance might even reimburse you more.  Multiple other Dr.'s who think you need xpap would be even better. 

There may be other members who have a better suggestions for you than mine as well.

[KonradVH]

I know the name of the Sleep Dr. who provided your test.  It may depend on his credentials as to how much compensation you receive.  My suggestion would:  if somehow you could get you PCP, or other Dr. (even a Dentist can write a prescription for a xpap machine) involved, then the insurance might even reimburse you more.  Multiple other Dr.'s who think you need xpap would be even better. 

How do you which doctor provided the test? Do they generally use the same one? The doctor is also within driving distance and covered by BCBS so I may look into meeting with him.

[Jay51]

That sounds like a good idea.  Good thinking.  I saw the name of this Dr. on my home Lofta sleep report back in 2021.  I recently (a week or 2 ago) saw a Lofta report uploaded here at ApneaBoard, and saw his name, and recognized it.  So I assume that he is the main (and possibly only Sleep Dr. that Lofta has employed).  I may be wrong though.  

The more clear that you can make your case to him about your insurance coverage; and the more Dr.'s that can get on board with you trying to either diagnose you with sleep apnea or treat you for it, then the more seriously insurance should take your particular case IMO from my experience.

If you can't meet with him in person, at least phone him to voice your concerns.