BlueCross/BlueShield Members Face New CPAP Usage Rules

If You Have BlueCross/BlueShield these New CPAP Usage Rules May Apply to You

For most BlueCross/BlueShield plans that use AIM Specialty Services to manage their CPAP benefits, we wanted to make you aware of some very important changes that might impact coverage for your CPAP machine and supplies. We know for sure that most BCBS patients in Maine, Mass, NH, and Connecticut are affected. Call BCBS member services on your card to be sure this applies to you.

BCBS requires data 4 times in the first year, and then once per year for supplies.

Starting August 1, 2014, to cover your device rental and ongoing supplies, BCBS no longer accepts your statement that you are using your CPAP device and now requires actual proof of usage. As you can imagine, this puts a new burden on you (and us) so that you can get the therapy and supplies you need. Here's how the process works:

  1. You are renting a CPAP device or need supplies
  2. We check to see if we have your data on file (hopefully you've already sent it to us)
  3. If not, we will call you and ask that you provide it to us
  4. We submit your data to BCBS and they approve the resupply order or rental
  5. If approved, we ship your order (or file a rental claim for you)
If we don't have your data, BCBS will not pay for CPAP or Supplies.

Starting this week, we need to make sure we have your data before we can bill your rental or ship any supplies.

We need your help. You have 3 options for sending us your data.

Option #1 SleepMapper
Sign-up for If you have Respironics equipment, you can upload your card every month from home. You will need a PC and an SD card reader. These are often built-in to the PC, or separate reader can be purchased for under $10. Click here to sign-up for Sleep Mapper.

Option #2 Online Submission
This is a very easy option. Submit your Machine data for the CPAP display using our online form. This is called VIC data and it's available right on your machine display. You will use the instructions given online, use the buttons on your machine to see the data right on the display. You then enter those numbers into our online form and hit submit. Easy! You can use this form every time you are eligible for supplies to submit your data. Click here to be taken to the instructions and submission form.

Option #3 SD Card Swap
Buy an new SD card and mail us your current card. We will upload the data and send a card back to you. You will need to send us your data card each time you require supplies.

Update your Machine
If you have a CPAP machine older than 5 years, contact us to see if you should upgrade to a newer one. Click here if you're interested to find out more.

. . . . . . . . .

We know this new BCBS policy is inconvenient and we would encourage you to call the BCBS member services number on your card to confirm this applies to you and share your thoughts on this new policy. But for now, we'll do everything we can to help you get the device rental or supplies you need as quickly as possible.

Questions? Please call us at 888.867.8840 and we'll be happy to assist you.

No comments:

Post a Comment