Well, folks, haven't visited in a while, I've been happily snoring away with my machine...
Just wanted to share with you a particularly gruesome insurance story, perhaps some of you will benefit by it.
I bought my CPAP machine directly from CPAP.com. According to my Humana group policy, it was covered 50% as an out-of-network expense, costing about $ 1050 with all of the bells and whistles (mask, etc.)
I realized that renting would be more expensive than buying direct, since I had a $ 250 deductible and it would go over a year to pay for the machine. Plus, I hated the equipment vendor and was happy to get rid of them after a few days renting.
Well, I submitted my claim to Humana in February. Here's their complete list of tactics they used to avoid paying the legitimate claim:
1) They accepted only mail claims. Believe it or not, the entire Humana claims department does not own one single fax. Strangely enough, they lost both of the mailed claims. The only way I was able to mail the claim in was to fax the claim into the general 1-800 number, and THEY then MAILED it into their OWN CLAIMS DEPARTMENT (I KID YOU NOT!!). By the time this happened, 2 months had gone by (we are at end of April).
2) They processed the claim incorrectly, denying because the codes were incorrect. I corrected the codes via a phone call with the knowledgeable, helpful people at CPAP.com. Another 21 day wait for "processing"
3) They finally deny the claim on the grounds that, despite my physician writing a prescription, the equipment was not pre-authorized. Note that during the entire time I was speaking to many individuals about the process I needed to go through, none of the mentioned the tiny fact that the equipment purchase needed to be pre-authorized.
UPSHOT - BUY EQUIPMENT ONLY THROUGH A DOCTOR IF POSSIBLE -- let them wrangle their way through the insurance morass.
Humana paid for the sleep study no problem, much more expensive. I guess because I'm not a provider, I'm just chop liver.
Cheerful though pissed off --