Health insurance said his CPAP was covered, then left him with the bill

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KANSAS CITY, Mo. -- “We’ve done everything that’s been asked of us,” said Marty Edwards, shaking his head as he explains the last eight months of frustration dealing with his health insurance company Blue Cross/Blue Shield.

The problem is a billing dispute over a nearly $800 portable breathing machine (CPAP) that Edwards’ insurance company promised him was covered yet has failed to reimburse him.

“That's why we called you,” said Edwards who has been using a CPAP machine ever since he suffered a heart attack 15 years ago. He’s never had a problem having his insurance pay for the machine until now.

The problem began last August when Edwards decided he needed a portable CPAP machine that came with a battery back-up. He called Blue Cross/Blue Shield to make sure it was covered under his plan.

“They said that was no problem,” Edwards said .

Edwards tried to purchase the machine in person at an Apria medical device store (Apria is part of his BCBS network). When he couldn’t find one in the store, he ordered it online at Apria Direct.

Online purchases have to be paid by customers upfront. Apria even warns online customers in a pop up box that if they expect to be reimbursed, they should check with their insurance prior to purchase. That’s exactly what Edwards had done, so he wasn’t worried.

That was eight months ago and Edwards is still fighting with BCBS to get his money back.

“It`s been back and forth, back and forth,” Edwards said. “We faxed. We emailed, everything.”

He’s even paid a couple of visits to BCBS office in downtown Kansas City.

“In a nutshell this is not looking very hopeful,” Edwards said.

Edwards’ wife Patti is equally frustrated.

“I can`t believe we are the first people who have come up against this in seeking personal reimbursement,” she said.

They definitely are not the first people, said Missy Conley of Medliminal, a company that specializes in helping people negotiate with insurance companies, doctors and hospitals to lower their medical bills.

Conley said it’s always tricky getting reimbursed for out-of-pocket expenses. For that reason, Edwards should have purchased the product from a company that would have billed his insurance directly.

Because he didn’t, his only option at this point is to contact the Missouri Department of Insurance and ask for its help.

Although that’s good advice, FOX4 Problem Solvers was hoping for a quicker resolution. We contacted BCBS. We wanted to know why BCBS hadn’t reimbursed Edwards for a device it had pre-approved?

Two weeks later, Edwards had his money.

A spokesperson for Blue Cross Blue Shield told us the company could not comment on the case, citing medical privacy concerns.

But two weeks later, Edwards received a check from Apria reimbursing him for the device.


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