Filing Claims for Durable Medical Equipment (DME) Frequently Asked Questions

• Why won't my local pharmacy file my claims for medical supplies, such as, needles and syringes?
• How do I file a claim for durable medical equipment?
• Are my diabetic syringes covered under my pharmacy benefit for the applicable copay?
• Are my diabetic test strips covered under my pharmacy benefit or my medical benefit?
• What if I require more diabetic test strips than those allowed under my pharmacy benefit?
• How can I find out more about my coverage for durable medical equipment and filing medical claim forms?

Why won't my local pharmacy file my claims for medical supplies, such as, needles and syringes?

Because certain medical supplies, such as needles and syringes, are considered durable medical equipment and they are covered under your medical benefit. It reduces the processing time when these claims are submitted directly to Blue Cross and Blue Shield of North Carolina (BCBSNC) rather than to Medco, the pharmacy benefits manager, first.

How do I file a claim for durable medical equipment?

Complete the Member Claim form and then submit the claim form with your receipt to BCBSNC for reimbursement. The charges will be applied to your applicable deductible and coinsurance just as if the pharmacy had submitted the claim for you.

Are my diabetic syringes covered under my pharmacy benefit for the applicable copay?

Diabetic syringes are covered under your pharmacy benefit for the applicable copay.

Claims for needles and syringes not related to diabetes will need to be filed by the member under the medical benefit. Examples include syringes for allergies, IV administration, sub-Q administration, etc.

Are my diabetic test strips covered under my pharmacy benefit or my medical benefit?

State Health Plan members may obtain diabetic blood glucose testing strips under the pharmacy benefit for a single copay. Insulin dependent members may receive up to 153 test strips and non-insulin dependent members receive 51 test strips per 30 day supply. The copay amount for these quantities depends on the brand of testing strips you use.

What if I require more diabetic test strips than those allowed under my pharmacy benefit?

You will still be able to acquire additional test strips above those allowed under your pharmacy benefit by submitting the medical claim form to BCBSNC, and it will be applied to your deductible and coinsurance.

How can I find out more about my coverage for durable medical equipment and filing medical claim forms?

You may contact Customer Service at BCBSNC at 888-234-2416 and a representative will be happy to assist you.