Wellmark Blue Cross Blue Shield of South Dakota – CPAP Coverage
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?
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
|Heated Tubing||A4604||1 per 3 months|
|Hybrid Mask||A7027||1 per 3 months|
|Replacement Hybrid Mask Cushion||A7028||2 per 1 month|
|Replacement Hybrid Mask Nasal Pillow||A7029||2 per 1 month|
|Full Face Mask||A7030||1 per 3 months|
|Replacement Full Face Mask Cushion||A7031||1 per 1 month|
|Replacement Nasal Mask Cushion||A7032||2 per 1 month|
|Replacement Nasal Pillow||A7033||2 per 1 month|
|Nasal Pillow Mask||A7034||1 per 3 months|
|Headgear||A7035||1 per 6 months|
|Chinstrap||A7036||1 per 6 months|
|Tubing||A7037||1 per 3 months|
|Disposable Filter||A7038||2 per 1 month|
|Non-disposable Filter||A7039||1 per 6 months|
|Oral Interface Mask||A7044||1 per 3 months|
|Replacement Humidifier Chamber||A7046||1 per 6 months|
|BiPAP Machine||E0470||1 per 5 years|
|BiPAP Auto Machine||E0471||1 per 5 years|
|Non-heated CPAP Humidifier||E0561||1 per 5 years|
|Heated CPAP Humidifier||E0562||1 per 5 years|
|CPAP Machine||E0601||1 per 5 years|
Wellmark Blue Cross Blue Shield – Customer Service Information
Want to Pay Another Way?
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.
Paying with Medicare
Health Sqyre works with approved Medicare providers in every state, as well as many Medicare Advantage health plans nationwide.
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.
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: