DME Billing Issues

[amandalee]

I get my CPAP supplies from Nationwide Medical. The supplies are delivered every three months. I would get an invoice shortly after the supplies were delivered. It made sense: supplies every three months, a bill every three months.

Recently, I started getting bills every month. I called and asked why I was getting so many more invoices, and the person I talked to said that they actually bill every month. Then she said that had an overdue balance of ~$150.

I explained that I keep very detailed records of my medical expenses and that I have paid every invoice they've ever sent me. So I'm guessing this is from invoices that I never actually recieved. Great. My mail is delivered to a locked PO Box, so it's not like someone was stealing my invoices, which means Nationwide must not have ever sent them to me.

I'm really, really upset. Basically, I'm being expected to pay invoices that were never sent to me. Has anything like this every happened to anyone else?

I'm having them send me the invoices they claim I haven't paid, and I'll check them against the invoices that are in my files. Any tips on how else to deal with this?

[Julie]

Yes, if you're records are in order and in sequence, all you have to do is copy the receipts, or whatever evidence you have of having paid for everything, and send them to their bookkeepers (what or whoever they tell you is their accounting facility), with a letter telling them to explain how you could possibly owe them anything.

[Paul56]

I'm really, really upset. Basically, I'm being expected to pay invoices that were never sent to me. Has anything like this every happened to anyone else?

Are you able to match up items on the invoices you do have with ALL the items you have actually received?
After that exercise are there no orphan items left without an invoice?
If so then there is a snafu with your DME accounting.

Steps to take:
-Go through the above exercise and make notes while doing so referring to your paper documentation.
-Immediately cancel the automatic deliver of supplies. Billing every month while only delivering supplies every 3 months is problematic in terms of record keeping. This makes no sense to me. If they question your cancellation then tell them you expect them to deliver an invoice for that batch of supplies being delivered... when they deliver... if there is no invoice refuse delivery. While the person is there match up items received with what is on the invoice... something wrong? Don't accept delivery.
-Once you have everything straight in your mind and on paper visit the DME in person and explain your side. Be firm, polite and courageous.

In accounting it is pretty standard that even though invoices may not have been received one is still expected to pay the outstanding amount for services or products when the invoice is finally received. You just need to ensure you really did receive the items listed on those missing invoices and that you are not being double billed.

[amandalee]

Thanks for the help.

I'm planning on cancelling the automatic delivery, as it is not "convenient" at all and is just causing me alot of stress right now.

It seems like I have had nothing but billing problems with Nationwide. I got my machine and started treatment back in July of 2007, but months later I actually had to call them and ask if they were going to send me a bill. And now there are apparently months worth of invoices from this year they have never sent me?
I'm not sure which is worse: having OSA in the first place, or having to deal with Nationwide.

[Arthurs]

Just curious, what kind CPAP supplies do you need every 3 months?

[Snoredog]

I get my CPAP supplies from Nationwide Medical. The supplies are delivered every three months. I would get an invoice shortly after the supplies were delivered. It made sense: supplies every three months, a bill every three months.

Recently, I started getting bills every month. I called and asked why I was getting so many more invoices, and the person I talked to said that they actually bill every month. Then she said that had an overdue balance of ~$150.

I explained that I keep very detailed records of my medical expenses and that I have paid every invoice they've ever sent me. So I'm guessing this is from invoices that I never actually recieved. Great. My mail is delivered to a locked PO Box, so it's not like someone was stealing my invoices, which means Nationwide must not have ever sent them to me.

I'm really, really upset. Basically, I'm being expected to pay invoices that were never sent to me. Has anything like this every happened to anyone else?

I'm having them send me the invoices they claim I haven't paid, and I'll check them against the invoices that are in my files. Any tips on how else to deal with this?

Have you ever gotten someone else's mail in your mail box? I know I have many times, wonder how many people actually put it back in the mail vs tossing it? If someone else got your bill because the mail man was dyslexic it could easily happen.

I would contact your Insurance company and talk to them about the invoices they have received for the period in question. These big companies think they never make mistakes but I've seen screw ups with AT&T, the gas company, the water company you name it. I used to work for a large software company that did only large Enterprise Applications such as the payroll for Toyota, Ford and others. I guarantee you even if your software package starts at $1 million, they have their share of bugs and screw ups even if the package costs $18 million and 6 months or more to implement. Even if the software is flawless, errors can be induced by the person typing on the keyboard.

[boston]

Is your DME local ??? I would pick up supplies in person and pay at time of pick up.

[goose]

Hey amandalee,
I had a very similar problem with my DME for a time. It sounds like your problem is a bit different, but I would get my every 3 months supplies and 3 months later I'd get an invoice as "Final notice" "pay or else" kinda deal....I called to find out what the deal was as I had not received any previous invoices and since my insurance covers 100% I didn't expect to get any invoices because they were paid directly by the insurance. Come to find out some bozo/bozette had coded my account as self-pay. Based on that I asked them why I didn't get an invoice to pay with the supplies, or at least one mailed prior to getting the threatening "Final notice".....They had no answer, so after being transferred around forever I had my account corrected, and canceled the automatic delivery "feature".....
Now I have to remember to call and request my 3 month supplies, but I don't get nasty invoices anymore.....
Good luck -- stay on them.......be that proverbial thorn!!!! (it can be fun if you don't get bummed by the whole situation!!!!)
Good to hear from you again -- keep us up on how it goes, and what steps you have to take to solve the problem!!!!

As for the question about what supplies are needed every 3 months -- I get filters - both kinds; a new hose; a new Humidifier Tank if needed (the M-Series tanks leak after a time if you faithfully clean them); a new mask if I request it......let's see....I think that's it....

Take care
cheers
goose

[amandalee]

Just curious, what kind CPAP supplies do you need every 3 months?

The shipments have included a new mask, with replacements for the part that actually comes in contact with your face (can't remember what it's called), new filters.

I don't know if I actually need these every three months, especially the new mask. I have never gotten a new humidifier tank though.

Thanks again for all the help. I guess the next step is to call my insurance company and check their records as well.

Re: someone else's mail in the box: I always put it back in the mail, but I can see how it could be misdelivered. But 2 out of 3 months worth of invoices every three months seems unlikely to me.

[amandalee]

Here's the latest development. The person I've been emailing at Nationwide about this issue just sent me a "financial hardship waiver." Here's what she had to say about it:

I am attaching a financial hardship waiver which upon approval will waive any co-insurance you may have. I hope this will help your situation so that you may continue to receive and change out your supplies as needed. Thank you, and please do not hesitate to contact our office toll free at..

Huh? I looked at the form and this is what it says:

This is to certify that Nationwide Medical, Inc. has provided me with the paragraph below to read. Furthermore, have attempted to collect my co-pay.
"When the provider accepts assignment, he/she is bound by law to accept the carrier's determination of the amount as full fee for the services rendered. He/she may not bill, or accept payment for the amount of the reduced charges. However, an attempt must be made to collect (1) percent of the approved charge relative to insurance coverage (co-insurance) (2) any amount applied to the deductible and (3) any non-covered charges, subject to the Limitation of Liability provisions."
Nevertheless, I have informed the provider, that such payment would constitute a financial hardship and am unable to make such payments.
I do hereby attest to the fact this statement is truthful, and is being signed at my request.

That's followed by a place to list my monthly income and expenses.

This doesn't really seem very helpful, because I probably make "too much money" (what a joke that is ) to qualify for a waiver. If they had sent me the invoices when they were supposed to, I would not have had any problem paying.

I'm really confused.

[goose]

Holy cow!!!!

Isn't the DME roller coaster fun????
Again, good luck!!!!
cheers
goose

[CpapMasks]

STOP THE PRESSES!

You are being being billed for "out of network" CPAP expenses. Call your insurance company, and find out who is local to you and in network, and these silly bills will stop. They are billing out of network, which mean who have a deductible to meet: until you meet that deductiable, the bills will keep comming. It is VERY VERY likely that you have "in network" coverage that is pretty darn good.

I'd bet my left ear.....ok, well maybe a dollar, that you rec'd your machine from a lab or a Drs office.

Get on the horn with your insurance company, find out who is in network.....then explain the situation to them, and they will transfer your info to a local supplier. After you get your new machine, call N'wide and have them send you a box to ship everything back!

Good Luck.

[amandalee]

Thanks for the info--I will give my insurance company a call. It's all very confusing.