Sleep Apnea Device Pre-Determination

To determine eligibility for sleep apnea devices, members must complete a pre-determination form to assess eligibility. This Pre-Determination will ensure the right member receives the right device, at the right time.

To ensure that we have the right medical documentation for you on file, Pacific Blue Cross will need every member requesting a sleep apnea device to complete the pre-determination process starting October 15, 2018.

How do I submit a Pre-Determination Application

1. Download the Pre-Determination form.
2. Complete the form and attach the requested documentation.
3. Fax the completed form to the fax number indicated at the top of the relevant form.
4. We will review the form and make a decision within 5 business days in most cases. You will then be informed of our decision. You can also view approvals in your Member Profile.

Frequently Asked Questions

• Sleep Apnea FAQ for Members