Can you spell MONOPOLY?

ballast949 · Post by **ballast949** » Fri Jun 03, 2005 8:40 pm

I contacted my insurance company (Providence Health Services) and tried explaining to them how I could save them a couple thousand dollars (and me a few hundred) if they would let me buy the equipment and they reimburse me. They tell me I have to rent it for at least 3 months before they will buy it. If I buy it "out of network", they will only pay 80% (90% in network). But, of course, I can't rent it on line, so I can't satisfy that requirement. And if I don't buy it from the DME who is renting it to me now, the rental won't count toward the purchase. And finally, I asked who else in the Portland Oregon area was an in-network DME. Turns out my DME is the ONLY in-network DME they have. And finally, guess who my DME is??? Why, Providence Home Services! I don't think I can win on this one.

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chrisp · Post by **chrisp** » Fri Jun 03, 2005 8:48 pm

2 choices.

1. Keep trying, talk to their supervisor. Keep elevating till you get the response you are looking for.

2. Bite it and buy online. You will probably be $ ahead in the long run when you figure all the hoops you have to jump thru. You'll get your machine sooner also.

Another Idea.

If the insurance is thru your employer get them involved. Its their $ too !

Boomer · Post by **Boomer** » Fri Jun 03, 2005 10:20 pm

I've been going through the same thing with my insurance, Aet-NO! (Aetna), thier DME is (oh no..) Apria, only. I would have to rent for 10months min., pay out of pocket for everything but the machine, and all at 2 and 3 times the price I can buy it online for.

I tried getting my employer involved, can't even get the person responsible to return a call or answer an e-mail...

So, guess what, I'm buying online, just waiting for my Rx. What a scam all this is.

rock and roll · Post by **rock and roll** » Fri Jun 03, 2005 10:56 pm

somehow we need to get this message out to where something can be done about it. What about a petition from this and maybe other forums to the boeard of insurance or whatever politician that could do something abiut it.

ahujudybear · Post by **ahujudybear** » Sat Jun 04, 2005 8:03 am

Is there a doctor in this field who is politically savvy and proactive for you?

In the field of Post-polio, Dr. Richard Bruno has been working with Senator Specter (NY?) to make changes in Social Security and now Medicare. They have gotten SSA to accept a diagnosis of "Post-Polio Sequelae" as a criteria for SS Disability. They are now working on Medicare's snap down on payments for powerchairs and scooters for people who need them for employment, etc.

Does the xPAP field have such a doctor to go to bat for them/us?

- JB

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