DME fraud?

[ChicagoGranny]

I was quoted $22xx for an AirSense 10 Autoset, $4xx for a humidifier, and $50 for tubing - billed to insurance of course.

These are the "list" prices. Your insurance company has much lower prices that have been negotiated with DMEs.

Call your insurance company and verify that this DME is in their network. Then find out what the negotiated prices are and what the insurance pays versus what you will be responsible for. Make sure you understand deductibles and out-of-pocket expenses - the insurance customer service can help.

Insurance strictly operates with HCPCS codes. Here are the relevant codes:

E0601 - CPAP or APAP
E0562 - Heated humidifier
A7037 - Tubing or A4604 - Heated tubing
A7030 - Full face mask
A7034 - Nasal mask or nasal pillows
A7027 - Hybrid mask

The insurance rep will be better able to help you if you use these codes.

[chunkyfrog]

Insurance reps do not know what these codes mean, and are instructed never to learn.
If they are caught with a cheat sheet, an angry woman in a black hood
strikes their knuckles with a wooden ruler.

[prodigyplace]

Can you go to a different DME? Who says you can't negotiate. This is a business transaction and they are not your guardian angels. Call around ..... simply say "I want NEW xxx machine/model, including x, x, and x. What is your price?" If it's over $1,000, ask them if is their best price. When you find someone in your ballpark, if you wanted you can go back to the original DME and tell them if they want your business, they should match the price you bargained, or you will buy elsewhere
.

My insurance said I was stuck with my DME because they were the ones who filed for preauthorization with the insurance company.

[chunkyfrog]

Find out who else is in network.
You are not indentured unless you have taken the machine home.
Somebody might be too lazy to do a little more paperwork . . .