Insurance Hassles (bait and switch I say)

[palerider]

I am sorry if I have confused anyone that surely was not my intent. I just want the benefits of the plan I pay for. I don't think that is unfair.

your whole thing seems to come down to "my DME was confused and tried to handle me according to the wrong insurance company policies"

well, (if I may be so blunt) DUH, the forum is RIFE with tales of DME incompetence, with things even less confusing than confusingly similarly named different insurance companies.

[chunkyfrog]

Confusion is their greatest weapon; that and the element of surprise.

[princessbelle]

Update on my insurance hassle with the DME and BCBS. The rental charges were all reversed and the Carelinc billed for a purchase and that was approved by BCBS. That said the purchase price increased 39% over the what would have been the total 10 rental.

Purchase Price $1555.00
10 Month Rental Price $945.30

I sent an email to Carelinc asking why the huge increase. I can hardly wait for that reasoning.

[chunkyfrog]

Easy. Somebody wants to overcharge you.
Don't let them.

[princessbelle]

I wasn't expecting to pay more for the dumb thing and I am arguing with them via email.

DME:We billed the purchase as 1250.00. That’s 50.00 more, which doesn’t even matter because they have an allowable amount so whatever extra we billed will get written off.

BCBS:Service Date Service Description Billed by Provider Network Discount Covered Amount Paid by Plan Your Responsibility
11/14/2014 Durable Medical Equipment $305.00 - $305.00 $244.00 $61.00
11/14/2014 Durable Medical Equipment $1,250.00 - $1,250.00 $1,000.00 $250.00
Totals $1,555.00 $0.00 $1,555.00 $1,244.00 $311.00


Me:Humidifier rental 10 months at $21.08 = $210.80 vs the purchase price of $305.00 a $95.00 increase that equals an increase in price of 45%

Cpap rental 10 months at $73.45 = $734.50 vs the purchase price of $1250.00 a $515.00 increase that equals in increase in price of 70%

It does matter to me because unless you accept the payment from BCBS as paid in full then 20% of the price is paid by ME. That is $121.94 increase out of my pocket.


I would think this would be illegal in someway, with so many laws who knows.

[Jay Aitchsee]

It does matter to me because unless you accept the payment from BCBS as paid in full then 20% of the price is paid by ME. That is $121.94 increase out of my pocket.

You might want to check on that. With most (many?) insurance companies, your copay (20% in this case) is a percentage of the insurance Allowed Amount not the Billed Amount.
But that said, there could indeed be a difference in the cost to you between a purchase and a rent to own plan as the insurance company may have different allowable costs for each type of transaction and, especially in this case, where it seems you've essentially been dealing with two different insurance companies as well.

[Krelvin]

Normally the humidifier is not rented, but paid up front when you first get you machine along with the mask, hoses, filters etc.. check to make sure you are not paying twice.

[princessbelle]

Jay the insurance allowed the amount billed for both the cpap and humidifier to the tune $1555.00. I contacted BCBS IL and they said whatever BCBS MI allowed there is nothing they can do.

I guess that means the DME will "write off" my co-pay. I think since he got an additional 70% profit the should at least throw in a mask.

[Jay Aitchsee]

Well, I understand your frustration. It is complicated and difficult to get a straight answer from anyone in the process. Of course, the old insurance company can't do anything about the new insurance company's policies - different companies, different states, different rules and regs, different policies and procedures. You are stuck with the policies of your current insurance company which dictate what and how an "in network DME" will be paid.
The only way I know that you'll be able to tell for sure what's been billed, allowed, and paid is by looking at your EOB. Unfortunately that's after the fact, but most companies have an appeal process, if your are not satisfied.

[deyasissa]

I have blue cross blue shield of Tennessee, $0 deductible plan, 20% co pay until $1500 and my plan is $302 a month. It's a PPO platinum plan so it pretty much covers everything without question. You guys should try checking platinum plans in the future, they cost a lot upfront but in the long run they save you a lot of money. Blue cross and blue shield is miserable at bronze status, you'll end up paying more in medical bills throughout he entire year.

I use a formula to calculate efficiency if insurance

(Monthly bill * 12 ) + out of pocket maximum

You want to get the plan that has the least total cost using that formula above. And more often than not the platinum plans end up saving you thousands, the only thing that's bad is it costs a lot of money upfront per month.