Conversations with an Insurance Company

[CollegeGirl]

I call my insurance company. I hold through about 30 minutes of "Your call is very important to us" before I am forced to leave a message and told I will be called back before the close of business hours.

I leave the following message:

Hi. I'm calling to find out how much longer you guys are going to be renting my CPAP machine before you buy it. I'd also like to just verify how often you'll pay for other CPAP supplies, including masks, hoses, and filters.

Two DAYS later("before the close of business" my foot) I get a call back.

Insurance Rep: Ma'am, I just wanted to call and let you know that we rent your CPAP machine.

Me: Yes, I know that. How much longer until you buy it outright?

IR: I don't know that information. Hold, please.

**Hold Muzak**

IR: I'm sorry, ma'am. My supervisor doesn't know, either. We're going to have to talk to the claims department, but they've already left for the day. Can we call you back tomorrow?

Me: Okay.

Next Day:

IR: Hello ma'am. We've talked to the claims department. We don't buy the machine. We just rent it indefinitely, until we've paid the entire purchase price.

Me: Okay, and how much longer until we've reached that point? It's been a year and a half now, and I'm still paying rental copays every month to Apria.

IR: Hold, please.

**more muzak**

IR: Ma'am, we don't know that.

Me: You don't know that.

IR: No. What was the purchase price of the machine? Maybe we can figure it out that way.

Me: I don't have that on me right now. You don't have the purchase price of the machine in your records?

IR: No. You could call Apria and ask if you wanted to.

Me: So let me get this straight. Apria just keeps billing you guys hundreds of dollars in rental fees every month, indefinitely, and you have no way of knowing when to stop paying them?

IR: Well...yes. I guess that's right. They're honest, though.

Me: (There are SO many things I want to say right now, but don't). *Cough.* Okay. Well, how about the masks, then?

IR: Eh?

Me: I had also asked you how many masks you pay for each year, how many filters, hoses, etc.

IR: Oh. I don't know. Hold, please.

**More &%^&$^& muzak**

IR: We don't know that. We'll have to check with the claims department and call you back tomorrow.

Me: (banging my head on the desk, now) Okay. Thanks.

They haven't called back. It's been a week.

I guess now we know why DMEs have so much power. ARGH!

[SelfSeeker]

I should not say this but thanks for the laugh.

Apira at this point is the one making the money.

I would assume that after 10 months or so, most machines should have been bought. Does Apira, have a rent to buy purchace, or do you lose the rental money?


It was hard convincing my insurance I wanted to do a straight buy.

What was even more surprising, but now I understand, when I called the Doctor's office for the follow up appointment, I was asked when does the one month rental finish? I guess, they give the appointments before the rental of the month is over. (Or how ever they are rented.)

Do you know for my insurance, I need a new Rx for each interface no matter how long I have the old mask.

As for filters and such, if you are renting, should they not be supplied as part of the rental package, not sure if the hose would qualify for that. For the filters, if you pay separate, see if you can convince them they are part of the cost of operating the CPAP. They need to be replace on a schedule, like batteries for a hearing aid.

[Wulfman]

AMAZING, isn't it??? It boggles the mind at how clueless these people are when it comes to spending your premium dollars.
I loved the "They're honest, though." part......

And people wonder why the medical costs are going through the roof.....

Good luck, CG.

Den

[CollegeGirl]

Glad it made you laugh, SS. That's why I posted it - I knew it would make people laugh. Heck, I'm even laughing! Insurance companies are ridiculous.

One would hope they would be reaching purchase price sometime soon. I traded in my RemStar plus for the auto 14 months ago. Even if the trade-in is the reason it's taking a while to pay off, it should still be completed sometime soon. I think I'll call Apria and see if I can get that machine purchase price - maybe they WILL be honest and tell me when it gets to purchase price.

If it's going to be too much longer (I graduate in May and lose this insurance I have) I'm going to have to see if I can talk to someone at my insurance company that actually knows what's going on and get them to buy it out before May.

[CollegeGirl]

Oooh, I forgot to add: She didn't even know which MACHINE I had! Oy!

[oldgearhead]

I had to stop using the services of both my DME and my insurance company
(BCBS) because of the stress. I use Yahoo Auctions, cpap dot com, and see
my RT once a year. I let the insurance pick up 80% of the RT cost. I buy
everything else outright. So far, I'm paying only a bit more than I was before.

[Guest]

Ouch. Puts into perspective the crap the DME companies have to go through every day. Ugh, I can't even begin to imagine having to deal with that for a living.
I also tried getting some of that information from my insurance company. I found I got a lot better results dealing with the billing department at my DME. They knew exactly what was going on a lot better than the insurance people did. That partly made sense to me though since this is what they do all day and the people at the insurance company have to deal with CPAP stuff, drugs, surgery, hospitals and basically everything. Stands to reason they aren't going to be experts on any one particular aspect of it.

[oldgearhead]

Why bother with the DME/Insurance Company stress?

My hardware costs (so far) for 2006:

Machine (used) $400.00
Aussie Hose 94.00
CL2 #1 94.00
Hybrid #1 175.00
Hybrid #2 60.00

Dollars lost on
3 mask trades = 66.00
-----------------------------
Total = $889.00

Co-Pay I didn't pay = $1125.00

Stress I don't have to deal with...Priceless

[justdan]

Wow, maybe you'll get a check back?

[Vader]

I had a similar experience talking with a health insurance rep,recently.
It boggles the mind, but of course it's no wonder why insurance costs are going through the roof, and they'll continue to climb higher and higher.<sigh>

[sleepyinsunnyvale]

Had the same experience with Apria and my insurance company.
I finally asked my insurance company if I could buy it myself and submit a claim. They said OK but I would only be reimbursed 70% not 90% since the purchase would be out of network. NO BRAINER!! My next call was to CPAP.com.
I then hand carried the Apria machine back to them. Didn't want to wait for them to pick it up. I wanted the pleasure of returning it and cutting all ties with them. Oh happy day!!!

[ignorant1]

The irony of a unit purchased “out of network”:

I have a 70/30 individual PPO policy with Blue Cross. They are willing to pay 70% of a highly inflated price to a DME (say 70% of $1,800 = $1,260). That means my co-pay of 30%, is $540 for a machine that I can buy for less than $500.

It gets even better. After working my way up the food chain to a supervisor:

BC: …well sir, if you purchase it out-of-network, we will only pay up to 50% of the “negotiated fee”, not 70%.
ME: How much is the negotiated fee?
BC: The negotiated fee is the amount that Blue Cross negotiates with each provider of medical….
ME: (interrupting) what I want to know is the dollar amount of the negotiated fee for a CPAP machine.
BC: We don’t have that information available, it depends on the supplier.
ME: If a supplier is out-of-network, doesn’t that inherently mean that BC doesn’t have a negotiated fee with that supplier?
BC: That is correct.
ME: Then how much is BC willing to pay for a CPAP machine purchased out-of-netowrk?
BC: We don’t have that information.
ME: What is the minimum/maximum range of pricing that BC authorizes?
BC: We don’t have that information available.
ME: Who does?
BC: It wouldn’t be available to you sir, it is confidential.
ME: It’s confidential? Why?
BC: The fees are negotiated with each company, and it wouldn’t be fair for the information to be known to other companies.
ME: I wasn’t planning to open a DME supply business anytime soon. I am the customer, not the supplier.
BC: Silence.
ME: So let me understand this correctly: I am required to pay my 70% co-pay of the purchase price for something that I am not allowed to know the price of?
BC: Umm… You could call different suppliers to see how much it is.
ME: I already did. It is more than triple the price than if purchased out-of-network.
BC: The price is determined by each DME supplier.
ME: Does BC have a list of preferred providers, and by preferred I mean suppliers that have lower prices than others?
BC: No sir, we don’t have a list like that. I can provide you a list of all providers however.
ME: So if someone calls in, looking to save themselves some money, as well as save BC some money, BC cannot help them determine which supplier to go to?
BC: No sir.
ME: Does that sound logical to you?
BC: It is BC policy not to direct the patient to any particular provider of service.
ME: When BC buys its company cars, do they go to the dealer and order a car without knowing the price, & just leave it up to the dealer to charge whatever they felt like?
BC: Sir?
ME: I know a car dealer that would gladly let BC pay only 70% of $100,000 for a Ford Taurus. BC’s paid amount would equal only slightly more than double the normal price – a bargain versus triple the normal price.
BC: Silence
ME: If I could PLEASE explain this to you once again, I can purchase a machine for less than $500. It is the same machine that BC is willing to pay 70% of $1,800 for, so BC is willing to pay $1,260 for the same machine that I can get for $500.
BC: I didn’t say that BC would pay that amount. BC will pay 70% of the negotiated rate.
ME: That IS the agreed upon negotiated amount per the DME; BC pays that amount to them as a matter of course.
BC: Yes sir, then that is the amount that they charge BC.
ME: I understand this. So BC is willing to force me to use a supplier that charges more than triple the price, so that BC policy is such that it assures that not only am I getting screwed, but BC is too.
BC: We don’t force anyone to go to any DME supplier
ME: BC encourages the use of a DME supplier that is in-network, correct?
BC: Yes.
ME: If I don’t use an in-network supplier, I am penalized by the BC policy of paying only 50% of a fee that they will not even disclose to me, is that correct?
BC: I wouldn’t say penalized, sir. You are free to use the services of an in-network provider.
ME: Yes, I understand. This seems to be a circular discussion, doesn’t it?
BC: Sir?
ME: How about if I call several in-network providers to find the one that will charge the most money?
BC: Silence.
ME: Then, BC would be paying SOOO much more money than they would pay even IF they would pay 100% of my purchase price for the same machine purchased out of network.
BC: No sir, BC will not pay 100%.
ME: Thank you for clarifying that for me, as I truly am not that bright & obviously cannot make any sense out of an irrational system. Could you please send me written documentation supporting the information discussed today?
BC: It is all in your policy, sir.
ME: No, actually it isn’t. I need the written documentation about the negotiated fees being confidential, and that BC will not provide assistance to either it’s members or itself to help determine the lowest cost provider of same-kind equipment, therefore wasting huge amounts of money.
BC: We don’t have any documents like that.
ME: I imagine not. I guess that when I bring this entire line of reasoning to the attention of the California Medical Board and the State Insurance Commissioner, they may be able to get to the bottom of this.
BC: BC policy complies with all regulations.
ME: I’m sure it does.
BC: Silence.
ME: Can I get information on how to open up a DME supply business? I hear they make an absolute fortune by ripping off insurance companies that don’t make any efforts in cost containment.
BC: BC makes every effort to save its members money by negotiating the best possible fees available.
ME: It seems to me that BC could use some better negotiators. I don’t really see much point in wasting more time on this conversation, wouldn’t you agree?
BC: Is there anything else that I can help you with today sir?
ME: Not right now. But when I find the in-network DME with the highest pricing on the planet, I’ll be sure to get back to you.
BC: Thank you sir, have a nice day.

[tomjax]

I gave up on all this foolishness a long time ago after getting the same garbage.

Why not just go to yahoo auctions and buy a remstar plus auto w/c-flex for less than 300.00 and save yourselves a lot of grief.

Get on e-bay too if you know the trick.
go to new listings- contact buyer and have them write you back with e-mail.
when it is pulled, make your own deal.

works for moi.
Yur choice.

[Snoredog]

then after you have rented for 20 months, paying all those copays and rental fees your job gets outsourced to India and you lose health insurance and are then really screwed (is that the same as being penalized?). At that point with Apria, you'll be stuck with paying those ridiculous rental payments each month on your own in addition to paying $380-$760 for COBRA (read the fine print of the agreement you signed when you got the machine).

Rent-to-own is the most expensive way to purchase anything. Apria knows this and makes a killing in profit off it, it is why they rent. To increase that profit even more, it is now doing OEM contracts with cpap manufacturers for their own branded machines (stripped down plain jane machines with even fewer features).

I seen this ripoff a long time ago and purchased my first machine outright. I also had Apria at the time with Aetna. If you got a letter of medical necessity from your doctor, a copy of the PSG, a copy of the Rx script and BILLED BC with the cost of the CPAP equipment (like from cpap.com) send it CERTIFIED mail, they would have to either reject or pay for the equipment pursuant to the policy. If your outright purchase is $700 and cpap.com is considered out of network, they would have to pay 50% of that amount or $350 of the $700 submitted bill.

It would be just like submitting a prescription for reimbursement. Might take several months for you to actually see your money, but they would eventually have to pay for the invoice or you file a claim against them and take them to small claims court.

If they rejected payment for whatever reason, you file the claim again and this time put "Demand for Payment" on the cover letter, then resend it Certified mail. Now they have 30 days to pay or reject the claim. Once they refuse or reject the claim again you are now free to file a small claims court case against them for 50% of the amount and court costs. That includes the $25 or so to have BC served with court papers.

Then if you take them to court and win, you ask the judge for punitive damages for bad-faith payment of claim (oh they hate bad-faith claims), then the judge can slap the maximum punitive damages to them, depends on your state, but many states have a $5,000 limit, some even higher.

If you file a small claim case against them, they'd have to send a representative to court or automatically LOSE the case, that has to cost them more than the machine.

They pay whom ever screams the loudest.

Most people think they get their masks for free because Insurance pays for it, you are paying for those masks each and every month in premiums weather you get them or not. Wouldn't surprise me if Apria was billing insurance like $280 month for machine and mask and so called ongoing "services".

[oldgearhead]

Wow! Ignorant 1, what a great post!

lol