Outdated machine

[Gmoyer3292]

Hello my cpap machine  is a 2012   I need a new one but insurance will not pay.

[Big Guy]

Hello my cpap machine  is a 2012   I need a new one but insurance will not pay.

Have they told why they won't pop for a new one?

[Gmoyer3292]

Yes  That is correct

[OpalRose]

Have you seen your Doctor about your Sleep Apnea and prescribing a new machine for you?

That would be the first step.

Then the Doctor would submit that perscription to a Supplier /DME.

Then the DME sends it to your insurance for approval.

[Gmoyer3292]

yes  we have already done that.

[OpalRose]

Well, you need to give us a little more detail. What reason did the insurance company give for not paying for a new machine?

[Gmoyer3292]

My bc/bs  insurance plan pays for  1  cpap machine  one time only.

[Sleep2Snore]

Well, what are your options, buy a second hand one and keep the old one as a back up and change your insurance company.

[Sleep2Snore]

My bc/bs  insurance plan pays for  1  cpap machine  one time only.

I find that a bit odd, but then the whole insurance system is a bit odd to me.

[Sleeprider]

Insurance policies vary with regard to durable medical equipment (CPAP), but I think you should not accept this answer. Your machine is probably a Remstar System One 50 series, but might be as old as the M-Series. It is now 7-years old and has outlived its useful service life. Be sure to get your prescription for a new auto CPAP in hand. Ask your doctor for a copy of the prescription, and request that he specify Auto CPAP, and preferably to specify the Resmed Airsense 10 Autoset. The reason you want an auto CPAP is because it has been many years since your last sleep study and the auto CPAP can automatically determine your therapy pressure. Since your current CPAP pressure is 10.0, a good range of settings for Auto CPAP will be 8.0 to 14.0 in auto CPAP mode.

With a prescription in -hand, research your BC/BS in-network providers. You can call for a list of providers or research online at the BCBS website. Select the supplier (DME) you want to use and give them a call. Read our Dealing with a DME wiki for what to do http://www.apneaboard.com/wiki/index.php...with_a_DME

The DME will research and explain your coverage through BCBS and take care of authorization. If after all is said and done it turns out you do not have coverage, or your copay and deductible are very high, you can choose to purchase a newer used device on outlets such as Craigslist, Offerup or Facbook Marketplace, or get a new machine from Supplier #33 who offers some of the lowest prices available on new equipment. A Resmed Airsense 10 Autoset costs about $600, and they offer complete setups with masks and tubing if needed.

Good luck, and don't take your first answer on coverage as truth until you have researched this. It would be very unusual for your policy not to include DME for CPAP, you just need to find a knowledgeable representative to talk to.