Wellmark Blue Cross Blue Shield of South Dakota – CPAP Coverage

 In CPAP Insurance Policies & Coverage, Insurance Guides

Great News – Health Sqyre Is In-Network With Wellmark BCBS South Dakota!

Health Sqyre has independent third party DME providers that are in-network with Wellmark Blue Cross and Blue Shield of South Dakota. If you are a sleep apnea patient, you can easily purchase your CPAP supplies with us using your health insurance online.

Wellmark Blue Cross Blue Shield CPAP Therapy Policy Highlights

The Wellmark blue cross and blue shield association’s medical policies can be confusing, when it comes to treating sleep disorders. That’s why we’ve compiled all the information you need about your CPAP insurance coverage under your bcbstx health insurance plan.

1. Does Wellmark Blue Cross Blue Shield Cover Health Care Supplies Needed For CPAP Therapy?

Yes.  Most all Wellmark Blue Cross Blue Shield PPO and HMO plans cover CPAP therapy supplies. This means that if you’re close to meeting your deductible, you may be eligible to buy your supplies at your coinsurance rate!

2. Is Home Sleep Testing Covered?

Yes, Wellmark Blue Cross Blue Shield covers and accepts a variety of home sleep tests. Health Sqyre will work closely with your health care provider to get you diagnosed in no time – shop our home sleep study using your CPAP insurance today!

3. What CPAP Therapy Supplies Are Covered?

The Blue Shield plan covers most continuous positive airway pressure (CPAP) supplies deemed a medical necessity for OSA (obstructive sleep apnea), including:

4. What CPAP Therapy Supplies Are NOT Covered?

In general, Wellmark Blue Cross Blue Shield considers convenience items and duplicate equipment not medically necessary and thus does not cover them.  The durable medical equipment not covered by your insurer under your benefit plan include:

5. Does Wellmark Blue Cross Blue Shield Require Compliance / Adherence For CPAP Therapy?

Yes. Wellmark 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.

6. Is Documentation Required To Get Supplies Covered?

Yes, Wellmark Blue Cross Blue Shield requires documentation to cover CPAP therapy supplies. This documentation includes relevant doctor’s notes, sleep test results, a prescription, among other items.

7. How Often Will Wellmark Blue Cross Blue Shield Replace My CPAP Supplies?

A comprehensive replacement schedule can be found further below:

  • Typically, filter replacements are every 30 days

  • Typically, tubing replacements are every 3 months

  • Typically, mask replacements are every 3 months

  • Typically, machines are every 5 years

Wellmark Blue Cross and Blue Shield of South Dakota – Reimbursement Schedule

Code Description

CPAP HCPCS

Usual Maximum

Heated TubingA46041 per 3 months
Hybrid MaskA70271 per 3 months
Replacement Hybrid Mask CushionA70282 per 1 month
Replacement Hybrid Mask Nasal PillowA70292 per 1 month
Full Face MaskA70301 per 3 months
Replacement Full Face Mask CushionA70311 per 1 month
Replacement Nasal Mask CushionA70322 per 1 month
Replacement Nasal PillowA70332 per 1 month
Nasal Pillow MaskA70341 per 3 months
HeadgearA70351 per 6 months
ChinstrapA70361 per 6 months
TubingA70371 per 3 months
Disposable FilterA70382 per 1 month
Non-disposable FilterA70391 per 6 months
Oral Interface MaskA70441 per 3 months
Replacement Humidifier ChamberA70461 per 6 months
BiPAP MachineE04701 per 5 years
BiPAP Auto MachineE04711 per 5 years
Non-heated CPAP HumidifierE05611 per 5 years
Heated CPAP HumidifierE05621 per 5 years
CPAP MachineE06011 per 5 years

Wellmark Blue Cross Blue Shield – Customer Service Information

Want to Pay Another Way?

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Paying with Cash

You can always pay out-of-pocket with Health Sqyre. Just browse our selection of CPAP supplies, click on a product, and you’ll see your cash price.

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Paying with Medicare

Health Sqyre works with approved Medicare providers in every state, as well as many Medicare Advantage health plans nationwide.

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Paying with FSA/HSA

You can use a flexible spending account (FSA) or a health savings account (HSA) to purchase most CPAP equipment as long as your FSA or HSA card is affiliated with a major credit card.

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Out of Network Providers

Most insurance carriers allow direct reimbursement for cash purchases – just submit your receipt with a claim form, usually available through your insurance company’s member portal.

Have Questions? We’re Here to Help.

Our dedicated customer support team is available to answer any questions you may have and guide you through your shopping experience:

Email: support@healthsqyre.com
Live Chat: Every day, 8am – 5pm (MT)
Call: Monday – Friday, 8am – 5pm (MT)  at 800-817-7118

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