How do I find out if insurance has a "capped" rental plan ?

Hi everyone. Haven't posted here in months, mostly because I'm doing so well with my machine (people who were here during the summer of 2013 might remember my wailing and panicking over not being able to get used to my Bipap machine.

I suspect my DME, Lincare, has been ripping off my insurance carriers for a while. When I first got my Resmed BiPap machine, the tech was more concerned about getting a check for $867.69 from me than about making sure I knew how to use the unit. The copies of the rental agreement tell me nothing. I can't read the carbon imprint of her writing. I recall that my direct payment bought me the humidifier unit outright, and the balance was to be applied to whatever monthly balance Mega didn't cover. Lincare billed Healthmarkets about $250 or so per month for the rental of the CPAP unit from May 2013 until I went on state Medicaid January 1, 2014 (Mega cancelled my policy). I don't know what they billed the state of CT monthly for my machine rental and CPAP supplies (Wisp cushions and tubing, paper filters) for the next nine months, since I didn't get an EOB (explanation of benefits).

Now I'm on Anthem BC/BS. They sent me a notice that they have authorized Lincare to provide services to me from Oct. 25 til January 22, 2015. I was able to translate the codes: they are approved to bill Anthem for the rental of my machine, the humidifier that I thought I already owned, and for tubing with a heating element. In the past 18 months I've only gone through 3 tubes and non of them were heated.

I suspect Lincare has been resetting the meter with each insurance change, hoping no one will notice.

I got copies of the Anthem EOB's for Lincare for October and November, and they are billing my insurance carrier $632.43 for the machine each month. I didn't see a separate listing for the humidifer (that I supposedly already own), or for any cushions or tubing or filters - which they promised to send 6 weeks ago and I'm still waiting for. Anthem allows $110.99 for this service. I am not responsible for the $521.44 Lincare is billing them, according to the EOB.

The situations still kind of sucks, because according to my EOB, the $110.99 I'm responsible for gets applied to my $2,400 per year deductible.

Seems to me I"d be better off just buying a machine directly. I could get a brand new one, and I've already got the humidifier.

These people suck.

I'm seeing my sleep doc tomorrow and I'm going let them know about this B.S., and I'm going to call Anthem as well.

How do I find out if insurance has a "capped" rental plan ?

Contact your insurer directly and ask them is the best way.
If there are questions about things before this contact that insurer.

Since payment is currently being provided via Medicaid, you might check to see if the state of Connecticut has a Medicaid ombudsman of some sort.

This might or might not be a good starting point:

http://connecticut.networkofcare.org/mh ... -1500.4150

After posting and going through my receipts and notes, it just dawned on me that I'm wasting money by dealing with Lincare. I'm going to ask my sleep doc at tomorrow's appointment to write me an Rx for a new Philips Respironics machine (I like my machine and I already own the humidifier). Then I'm going to call Lincare and tell them pick up their machine. My deductible with Anthem is so high that it doesn't make sense to rent the machine anymore or buy the supplies through the DME.

I'm just disgusted at the fraud I've uncovered with this one appliance. No wonder our health care costs are out of control. Lincare tries to bill the insurer over $600 per month for a machine that retails at under $1,400.? Brass balls.

yep, for the package my DME provided (Resmed S9 Elite, H5i humidifier, Climateline hose, and Airfit F10 ffm) they billed my insurance somewhere around $2200, thru the hosting website (cpap.com) the same stuff is (or was last time I checked) somewhere around $1100, buying thru Amazon.com you can save another $100 or so.

The guy selling on amazon is making a profit at what he is selling the stuff for, the B&M DME provider business must be a good business to be in!

The amount they bill isn't fraud. It's a game. They know that they will get what Anthem Blue Cross deems to be "reasonable" regardless of what they put on the bill. This is SOP for all dme's, their motivation is now they can show "losses" when negotiating contracted prices. Everyone in the industry plays along.

But there WAS fraud in your case. Lincare charged for a new machine and humidifier at least three times--each time you changed insurances. In particular, you purchased the humidifier outright the first time and they charged Medicaid and Anthem for what you already OWNED. Plus, they should have credited you for months of capped rental each time you changed insurers OR replaced your machine with a brand new one. They should be reported for this fraud--letting it go gives them permission to keep repeating this fraud. If you let them slide they have no incentive to stop doing it to others.

Report them to your state's Medicaid fraud unit and Anthem blue cross. Plus any state health insurance commission and licensing agency. Don't let these creeps win!

Possible assistance for you find your state
http://www.seniorsresourceguide.com/dir ... onal/SHIP/

I have been complaining about this practice for 15 years, to anyone who will listen and many who would rather not.
I just got a letter from Crapria confirming that my perpetual rental has now been converted to paid in full ownership.
It only took 3 grievences filed with the insurance company, multiple calls and visits to Crapria and conversations with my doctor and medical group. They were charging $393/month rent for ever for my ASV machine which retails for $3600 on Phillips web site.