CPAP lease agreement

[Big Guy]

I have the Federal Version of Blue Cross / Blue Shield. I received my CPAP on 9-10-18. I've been 100% user compliant, and it's now been 98 nights of use. 

I called BC / BS and asked them about a compliant period. I was told that they don't have one. The way they do it, is that once the purchase price of the machine / equipment has been met, the lease is up. Or.....after 13 months of use, the lease is terminated. I guess, which ever comes first. 

The person I was speaking to, didn't seem to be all that well informed on their CPAP lease program or rules. She tried as best she could to answer my questions, but I still feel somewhat in the dark as to what to expect. 

My portion (co-pay) of the lease is a little over $9.08 per month. I suppose I'll just wait a couple of more months and see what happens. Then, I may call back to BC / BS and bring it back up. 

Does this make sense to anyone? If so, or, if you can elaborate some and school me on the subject, it would be appreciated. 

I'm confused and I admit it. 

[srlevine1]

Most insurance companies track compliance to ensure you are using the device. "Blue Cross Blue Shield requires adherence and will only cover a medically necessary PAP device beyond the first three months of therapy when PAP use is greater than or equal to 4 hours per night on 70% of nights during a consecutive 30 day period during the first three months of therapy." Sort of standard with most companies.

Some BCBS licensees consider the device under a rent-to-own plan with a short time period of 6 - 7 months after which you assume ownership. Others consider that your rental terminates after 13 months and then you own the machine.

If you require a definitive answer, write your BCBS plan administrator and ask your questions. When dealing with insurance companies, it is always better to have written answers. If you call, remember to document the date, time, person, and the essentials of the conversation to create a contemporaneous record if you are ever challenged.

Get a good night's sleep for a better tomorrow.

[Big Guy]

Thanks for the response. It's appreciated.

[mfac11]

I have the Federal Version of Blue Cross / Blue Shield. I received my CPAP on 9-10-18. I've been 100% user compliant, and it's now been 98 nights of use. 

I called BC / BS and asked them about a compliant period. I was told that they don't have one. The way they do it, is that once the purchase price of the machine / equipment has been met, the lease is up. Or.....after 13 months of use, the lease is terminated. I guess, which ever comes first. 

The person I was speaking to, didn't seem to be all that well informed on their CPAP lease program or rules. She tried as best she could to answer my questions, but I still feel somewhat in the dark as to what to expect. 

My portion (co-pay) of the lease is a little over $9.08 per month. I suppose I'll just wait a couple of more months and see what happens. Then, I may call back to BC / BS and bring it back up. 

Does this make sense to anyone? If so, or, if you can elaborate some and school me on the subject, it would be appreciated. 

I'm confused and I admit it. 

I'm not terribly surprised that the CSR you were speaking to couldn't answer your questions satisfactorily.  Seems the rental period can vary from carrier to carrier and even plan to plan.  

I'm on an individual plan (not ACA) with Florida Blue.  The rent to own period varies between their PPO, HMO and Medicare plans.  

If you have a hard time getting anywhere with your plan administrator, you might try calling your DME and asking to speak to the billing specialist who handles federal BC & BS claims.  They should be familiar with the process since they have to submit the bills to Blue Cross monthly until the machine is paid off.

[Big Guy]

I have the Federal Version of Blue Cross / Blue Shield. I received my CPAP on 9-10-18. I've been 100% user compliant, and it's now been 98 nights of use. 

I called BC / BS and asked them about a compliant period. I was told that they don't have one. The way they do it, is that once the purchase price of the machine / equipment has been met, the lease is up. Or.....after 13 months of use, the lease is terminated. I guess, which ever comes first. 

The person I was speaking to, didn't seem to be all that well informed on their CPAP lease program or rules. She tried as best she could to answer my questions, but I still feel somewhat in the dark as to what to expect. 

My portion (co-pay) of the lease is a little over $9.08 per month. I suppose I'll just wait a couple of more months and see what happens. Then, I may call back to BC / BS and bring it back up. 

Does this make sense to anyone? If so, or, if you can elaborate some and school me on the subject, it would be appreciated. 

I'm confused and I admit it. 

I'm not terribly surprised that the CSR you were speaking to couldn't answer your questions satisfactorily.  Seems the rental period can vary from carrier to carrier and even plan to plan.  

I'm on an individual plan (not ACA) with Florida Blue.  The rent to own period varies between their PPO, HMO and Medicare plans.  

If you have a hard time getting anywhere with your plan administrator, you might try calling your DME and asking to speak to the billing specialist who handles federal BC & BS claims.  They should be familiar with the process since they have to submit the bills to Blue Cross monthly until the machine is paid off.

Yes......I just might do that. Thanks for the idea!

[Big Guy]

I called the DME company (Rotech) today and asked about the lease program and how it worked. 

I was told that on Oct. 9, 2019, my CPAP machine will be paid for in full. I physically took possession of it on Sept. 10, 2018. My insurance co-pay amount is $9.08 each month, regardless of any re-supplies that may be sent automatically, or any that I request specifically.

At least now, I have a full understanding of how the lease program works and when exactly the machine becomes mine.