Deductible

[Graceryan06]

I got my CPAP on October 2nd, 2014. The lady at the DME shop said that I had to pay my $250 deductible. I paid it that day and today I received a statement from my insurance stating that they had paid for it all and that I shouldn't have had to pay the deductible. I called my insurance and verified it with them. They told me that I had to call the place where I got the machine and tell them I needed a refund because I didn't have to pay the deductible. Friday is the earliest day that I can do this. Has anyone had this happen to them and how easy would it be for me to get the money back? Thanks!

[chunkyfrog]

Sometimes they take care of it within a month, maybe sooner.
Be ready to show them written proof from your insurance, and that you expect quick resolution,
-- before you order any additional supplies from them.

[jencat824]

Did you pay using a credit or debit card. If so, after you request your refund & if they don't send it in a reasonable amount of time, you may be able to get the transaction reversed. Just something to keep in your mind as a backup plan.

Jen

[Graceryan06]

Yes, I did use a credit card so I will keep the reversal thing in mind. They also told me that I could only replace my hoses and masks once a year. My doctor told me last week that I needed to get a new supplies every 3 months for the hose, I believe. I can't quite remember the months for replacements. Can I switch to another DME within my insurance plan or am I stuck with this one?

[mike1953]

You need to call your insurance for that information

[Pugsy]

Yes....you can use another DME for mask and accessories.
You do need to call your insurance company and find out what other DMEs might be in your area that are part of the "in network" for your insurance so that you can maximize your insurance benefits.
Once a year is ridiculous...even Medicare does a lot better than that.
You need to find out from your insurance company as to exactly what their replacement schedule might be. Most will mimic Medicare's replacement schedule but find out directly from your insurance company what their schedule is...do NOT rely on what the DME tells you.

I have heard of a few insurance companies that have a severely limited once a year schedule for replacement parts or masks...not impossible but it is rare. You need to know exactly what your coverage is.

[Krelvin]

YES! I had this happen recently. I was already past my deductible max but the DME said they had to charge me the deductible ($78.00), as soon as I got home, I called the insurance company and confined for the 3rd time there should not have been a deductible, but until the DME filed the claim they couldn't due anything.

5 Days later the claim was filed and the insurance called the DME and told them to issue a refund, took about 2 weeks but I got it.

[Denial Dave]

Personally, I'd refer your DME to your insurance company for disputing payments & policy coverage.

but that's just me