So angry and upset at "that" DME provider

[Ineedanap]

I have that hated provider, they've done nothing but prove their horrible reputation. I signed for the rent to buy on my CPAP. 17 a month and pay something like $65 for my accessories. They didn't mention that because I hadn't already paid toward my $500 deductible, that was going to have to come first. I paid, and moved on with life. Come January, surprise! Its a new year, time to pay another $500 deductible. My insurance covered machine is going to cost me $1000 over two years something "that provider" never mentioned either.
I'm not sure how I'm going to pay the deductible and might have to give my machine back and buy one of the cheapies on CL just so I have something. Why the heck is this company still in business? How can they go to sleep at night knowing they're doing this to people?

[LSAT]

I certainly will not defend your DME, but, I don't think they would have any idea how much of the $500 deductable you had already paid...(if any). All they would know is that your insurance covers the CPAP. They don't have access to your health/insurance records.

[lcook7281]

I would contact your insurance company. They might be able to work something out since this is technically an item you purchased last year and are making payments on this year.

Lsia

[Janknitz]

I am by no means a fan of that DME, BUT, this is NOT something they are doing to you. This is your insurance company.

This is exactly why you will see many of us advise newbies to CALL your insurance company before you ever walk into a DME and find out EXACTLY what your insurance company pays for and how they pay it. It's important to know what the deductible is, how often the deductible rolls around, and what your monthly payments will be to calculate your out of pocket costs. THEN once you know exactly what your out of pocket costs will be, you can compare apples to apples by shopping around online to see if your insurance coverage with a DME is really the best deal for you.

If you are unhappy about paying the deductible twice it's NOT the DME's fault--call your insurer and see if there's something you can work out (unfortunately, probably not). If you have a choice of insurance providers (not many of us do), next time you should factor the deductibles for DME into your consideration about which plan to get.

Certain DME's deserve their reputations for some truly lousy practices, but it's unfair to blame the DME for this one. This time, it's all on your insurer.

[motherall]

I have that hated provider, they've done nothing but prove their horrible reputation. I signed for the rent to buy on my CPAP. 17 a month and pay something like $65 for my accessories. They didn't mention that because I hadn't already paid toward my $500 deductible, that was going to have to come first. I paid, and moved on with life. Come January, surprise! Its a new year, time to pay another $500 deductible. My insurance covered machine is going to cost me $1000 over two years something "that provider" never mentioned either.
I'm not sure how I'm going to pay the deductible and might have to give my machine back and buy one of the cheapies on CL just so I have something. Why the heck is this company still in business? How can they go to sleep at night knowing they're doing this to people?

Your anger while real is misdirected. Your DME provider has no control over your benefits nor would they have knowledge of them. It is your responsibliity to either know your benefits and call your carrier to find out. That $500 could have been due any other provider...it just happened to be the DME who sent one of the first bills

[Ineedanap]

I guess maybe its the way I wrote it. When I was sitting in the DMEs office, the guy sat down with me, explained my equiptment, how it worked and how to care for it. He also went over a sales service and rental agrement. It included information gathered by contacting my insurance company. It included their charges for the equiptment, how much of that my insurance company had agreed to pay and how much I was responsible for. He swiped my credid card for my portion and I left with a signed agreement to pay x amount monthly.
I later found out that my insurance company refused nearly 500 of those charges due to unpaid deductable. I paid it and moved on. Deductable was never mentioned verbally or in my contract, I have never paid the nice low contracted charges or 17.50 per month I agreed to. I believed they had fully investigated my insurance coverage on my behalf and that I was signing a contract to pay the only the amount on the sales service and rental agreement I was signing.

[Elle]

I have to pay the deductible every January for my insurance before I get anything covered. Don't they all work that way?

[dragonflybeach]

I, too, am little confused by this one. I understand the deductible needs to be paid every year but, Ineedanap already has the machine and a signed contract. The deductible was paid in the year Ineedanap took possession of the machine, therefore, s/he should be paying on that contract. Was a new contract signed or a new device issued? If not, then IMHO, the deductible does not need to be paid again to the DME. Now, if s/he goes to the doctor for a broken finger, then yes, you'll need to pay the deductible to the that provider.
Of course, every insurance provider has their own rules---always best to call your provider and verify what is happening.

[MsBea]

Why are you renting instead of buying? If you purchased, you'd pay your deductible and the 20% coinsurance and then you'd be done paying for it.

[Ineedanap]

Why are you renting instead of buying? If you purchased, you'd pay your deductible and the 20% coinsurance and then you'd be done paying for it.

Right?! Its how my insurance company does it. They rent to own. Had I known it was going to cost me $1000 over two years I would have bought it on Craigslist or outright from another provider. Instead I went with them believing I would be paying $17 a month and it was so much easier than going to a brick and mortar or buying it on my own.

When I go to the dentist , they tell me its going to cost X dollars, that X amount of that is going toward my deductible. They've even discussed having things done before January to be part of this years deductible, or after January when my coverage renews if I used it all.
I cant be the first patient with a deductible and I cant be the first one surprised by paying it twice on the same item. I trusted that they had done the leg work for me and the paperwork I have makes it appear they did.

I did call both the DME and the insurance company, I'm stuck. I can either return the rental equipment and buy my own outright or continue to pay the full amount per month rental until my deductible is met and/or the rent to own period is completed.

[Pugsy]

If your insurance company had used a 13 month rent to own like Medicare then only one January deductible would have applied. Your insurance company uses 17 month rent to own and unfortunately the timing of the initial acceptance of the machine during the calendar year meant that the contract rolled into another January before the 17 month requirement was satisfied. If your initial acceptance had been in earlier in the calendar year then you would have only hit January once.

While it would have been nice to have a warning from someone about the fact that a second January was going to enter the equation it really is a patient's responsibility in the end..to know exactly what a contract will mean.

You didn't think far enough ahead about what would happen when those 17 months entered into a second January did you ? I imagine that the supplier did not either. 17 month rent to own is not common at all. I feel your pain an anger but some of the responsibility falls on your shoulders. If you knew 17 months you should have counted forward to see when contract ended and when you saw it involved a second January...you should have asked.

[Ineedanap]

I imagine that the supplier did not either. 17 month rent to own is not common at all. snip ...you should have asked.

Oh I bet my supplier knew full well, and has spent the last few months dealing with customers as surprised and angry as I am.

I actually did ask. I said, oh is that all? He said yes. I said, I can afford that and signed what I thought was a thorough explanation of charges and what my portion of those charges would be.. Every other doctor or specialist I have ever seen, has contacted my insurance company and any charges explained to me have always included my deducible if any.

I fully expected to pay my deductible for my sleep study but they checked with my insurance company and my portion of that was $100 and that's what I was charged, not $100 plus deducible that year and again the next year.

I don't have a 17 month rental, it was $17 a month. Its now $75 a month until my deductible is paid.

Anyway, I really feel like I am having to defend being surprised about equipment I bought cost $1000 more than the contract I signed and that my supplier absolutely knew this when they had me sign that contract.

[greatunclebill]

it's over and done and you learned a costly lesson about fully discussing things with the insurance company and not so much the dme. at this point it is about frustration and not answers, so do yourself a favor and move on.

i think the thing that is missed in all of this is that you are going to pay a $500 deductible once a year to the insurance company no matter what billing it is applied against. whether the $1000 across 2 years is applied to the cpap or doctors office visits, you're still paying it. should you have been told step by step? maybe not. it is not their responsibility. should you have asked step by step with the insurance company and not the dme? absolutely. it is your responsibility.

it's about taking personal responsibility for your insurance stuff. if my doctor orders a specialist visit and the nurse gives me an appointment and says it's covered, you better believe i am on the phone to my insurance to make sure it is in fact approved and i do not go until the insurance company tells me it is approved. same thing with our cpap's. the insurance told me they were covered before we ever took possession. trust no one and verify, verify, verify. in the end you pay. in the end it's all your responsibility.

[Pugsy]

So sorry if I misunderstood the 17 month thing.
It doesn't really matter how many months the rent to own agreement is if it encompasses 2 Januarys.
If it were 14 month contract and the machine was dispensed in Dec...2 Januarys are going to be involved.

I do understand you frustration and anger..believe me I do. No one likes a $500 surprise bill no matter what the circumstances. I would be angry also. I would be angry at the DME for not filling me in and I would be angry at myself for not doing due diligence and checking things out fully myself.

And even though I would know that I had some of the responsibility...I am a spiteful little witch when I get mad..I would probably take my cpap supply business elsewhere just out of spite. The machine..no..that is too much money to have to do all over again but any masks and other supplies..they would be coming from alternate source if at all possible. I just wouldn't want them to have one more penny of my money than I absolutely had to give them.

So check with your insurance company to see if there is another cpap supplier than you can use your insurance with. That $500 deductible gets satisfied no matter who or what initiates the deductible. Further supplies or other medical services will now have that deductible satisfied.
Yes, it sucks but other than ranting and taking our business elsewhere..there really isn't much more we can do.

[VikingGnome]

Put all your medical expenses for a year in one pot. The $500 deductible will apply to anything in that pot. So if you had minor surgery, a few doctor visits, x-rays or expensive MRI, the $500 would come out of those. But since you've paid this year's deductible to the DME, all those other medical expenses will cost you a lot less. Don't think of it as the DME got more than their fair share. They were just the ones that filled before you met your annual deductible. Your CPAP didn't cost you $1,000. The DME just happened to get both deductibles from you instead other health providers. Without the CPAP the $1,000 would have paid somebody else.

See if the DME is willing work out a monthly payment plan, say $50 per month for 10 months.