Help! Supplier inflates bills. $1950 for $868 CPAP machine?!

[mike1953]

It is rare that a DME after 30 days will do anything. Good Luck.

[M'ohms]

I had prearranged with my insurance company to forgo the rental period and to do an outright purchase instead. After getting their approval, I told the DME our arrangement. If they won't go for an outright purchase, then find another DME who will. I have done this with 3 machines and an oxygen concentrator.

One DME, for example, only did oxygen business on a monthly basis. My concentrator would run $79 per month. Every month. Forever! I would never own it. After walking out, I went to a DME half the distance to my house and did an outright purchase on the same concentrator for a total out-of-pocket of $97 which included all the trimmings. Believe me, it is not only in your best interest to make these arrangements, but also you insurance company's. Their payout will be less also.

You say you were told that you need to replace your humidifier every 3 months. I think you mean humidifier tank. My experience is that you really only need to replace the filters on the machine that regularly. Perhaps mask cushions, but mine hold up a lot longer than that. Headgear, maybe at 6 months. YMMV. After 2 1/2 years, my humidifier tank is still in perfect shape, as is my hose and mask. I suggest you order replacement filters and get a feel for the wear and tear on your other supplies before setting up any kind of scheduled replacement order. Ideally, you should have a spare hose, cushion, and other disposables on hand in the event of an accident, though, so once you find your perfect mask, you should have a backup on those things. At 3 months, you could do a complete reorder of everything, just to have the backups, then just the filters until you actually need to replace something. This is assuming that you really like your mask. Otherwise, every 3 months, you could try a different mask until you find a winner.

[lindalrc]

I second the suggestion to see how long supplies last. It will vary by person and item. It is not a bad idea to have a back-up set of replacement parts on hand.

Based on my and my husband's experiences:
1. Hoses: they are almost immortal, but we had one develop a leak once. They can be repaired, but best get a new one if there is a leak. However, we just started using the new heated hoses so not sure how that will go. I worry more about a crack in the electrical wire. We have replaced the standard ones about every 12 to 18 months.

2. Masks: The plastic portions of the masks are immortal (as is plastic) unless jumped on.

3. Cushions: The silicone facial cushions are NOT immortal - we change ours out at 2 weeks and that keeps the leaks WAY down. We have not always changed so frequently. I used to go about 2-3 months; he used to go 6 months. Apparently my facial oil messes up silicone faster than his facial oil. But if you get leaks even when washing, it is time for a new cushion.

4. Head gear: This does need replacing - perhaps at 6 month to yearly intervals. Ever so slowly they stretch, and even with the velcro adjustable straps, they loose their capacity to move as you do. Just got a new head gear - should have done it a while ago. Another issue on head gear. The standard that comes in a mask package is MEDIUM. I need a small, and so it has to be ordered separately. Just keep in mind that there are other sizes than the default.

Our DME gets upset that we don't take entire new masks and hoses at 6 month intervals. Don't need that - just the cushion change does a refreshment. And my head gear is a separate order anyway.

5. Humidifier tanks: If they are not leaking and the seal is good, these do not need replacing (1) if you use distilled water (tap water OK on occasion such as a two day visit); (2) if you clean it at least once a week; (3) if you don't drop it from a height. My DME indicated concern about buildup of bacterial film. This is controlled by the distilled water AND by an occasional soak in vinegar water and even scrubbing the inside with a damp cloth. You can buy ones that are dishwasher safe though I have never done that. There are several discussion lines on this web site on cleaning humidifiers and the other gear.

So good luck. This is a new venture and a new learning curve. This forum can help to get through it.
lindalrc

[chunkyfrog]

+100 to the above.
I would also add that it's a good idea to get one spare hose, as early as it's covered.
---in case of damage, by pets, or self --just too drowsy to not be a klutz.

[dadashek]

Hi,
I just experienced a similar issue with Cigna.

Healthline medical is the local equipment I work with to get my supplies. I tell them what I need and in turn they get it approved by Carecentrix (Cigna's medical equipment program administrator) and the equipment is sent to me. It has not always been a smooth process, but generally it worked ok because inside the box with the medical equipment for my CPAP was a Delivery Ticket with an itemization and price listed for each piece of equipment. On its face those documents told me everything I needed to figure out the price I was going to pay. As well, there was a bold section called Insurance and listed there is the name Carecentrix. So, ok no problem Carecentrix works with Cigna the cost on the Delivery Ticket is the price I will pay. Clearly, the delivery ticket is important since it allows me to decide if I want to go into the open market and decide to purchase the equipment on my own and send the equipment back or accept the insurance pricing and keep the equipment.

That was until today when I called Carecentrix because of billing irregularities and found out that the actual bills they'd provided to the insurance company were completely different than the ones Healthline reported on the Delivery Ticket. I calculated that difference to be $397.36 on the Healthline Delivery Ticket and $562.44 as what was reported by Carecentrix to the insurance company, that is a difference of 41.54% that will now be applied against my deductible. I am being told that since the transaction is already done, it cannot be undone so I just pay the cash price.

The strangest thing these guys never thought about is that I then turn around and submit this massive difference to my FSA provider who uses my pre-tax dollars and makes me whole for this inflated deductible amount (that is, the tax I am not paying is being subsidized by the government, in other words, they just screwed the US government).

This is wrong and wreaks of an unclear and unfair process that was devised to defraud the public. Why introduce a third party like Carecentrix into the mix unless you are out to screw people, since clearly they only increased the cost and instead of Cigna having to defend their agent's behavior they blame it on Carecentrix. Carecentrix is clearly Cigna's agent and by that CIgna is defrauding the government through inflated FSA expense. Just beautiful.

[dadashek]

Hi,
I just experienced a similar issue with Cigna.

Healthline medical is the local equipment I work with to get my supplies. I tell them what I need and in turn they get it approved by Carecentrix (Cigna's medical equipment program administrator) and the equipment is sent to me. It has not always been a smooth process, but generally it worked ok because inside the box with the medical equipment for my CPAP was a Delivery Ticket with an itemization and price listed for each piece of equipment. On its face those documents told me everything I needed to figure out the price I was going to pay. As well, there was a bold section called Insurance and listed there is the name Carecentrix. So, ok no problem Carecentrix works with Cigna the cost on the Delivery Ticket is the price I will pay. Clearly, the delivery ticket is important since it allows me to decide if I want to go into the open market and decide to purchase the equipment on my own and send the equipment back or accept the insurance pricing and keep the equipment.

That was until today when I called Carecentrix because of billing irregularities and found out that the actual bills they'd provided to the insurance company were completely different than the ones Healthline reported on the Delivery Ticket. I calculated that difference to be $397.36 on the Healthline Delivery Ticket and $562.44 as what was reported by Carecentrix to the insurance company, that is a difference of 41.54% that will now be applied against my deductible. I am being told that since the transaction is already done, it cannot be undone so I just pay the cash price.

The strangest thing these guys never thought about is that I then turn around and submit this massive difference to my FSA provider who uses my pre-tax dollars and makes me whole for this inflated deductible amount (that is, the tax I am not paying is being subsidized by the government, in other words, they just screwed the US government).

This is wrong and wreaks of an unclear and unfair process that was devised to defraud the public. Why introduce a third party like Carecentrix into the mix unless you are out to screw people, since clearly they only increased the cost and instead of Cigna having to defend their agent's behavior they blame it on Carecentrix. Carecentrix is clearly Cigna's agent and by that CIgna is defrauding the government through inflated FSA expense. Just beautiful.

If you want to let the government know your story post it here:
CFPB website -> help dot consumerfinance dot gov backslash tellyourstory

[70sSanO]

You have to weigh out the cost after the deductible. 5 years ago I ended up going with a brick & mortar DME, usually I online it but my insurance company wouldn't accept an online DME. They provided a new mask every 3 months and I was charged 10% after I met my deductible, which happened with the machine. I'm still on the first mask, with 3 new ones waiting as replacements. I do get around 2-1/2 years out the cushion. A lot depends on how high the pressure is set. Lower pressures allow for less leaks with an older cushion. I use elastic straps covered with headbands and I have yards of elastic.

I think I only had to pay one deductible, but that was 5 years ago and greed is constantly escalating. You need to find out from your insurance company.

John

[Omne]

Insurance is strange. I got a bill for the initial setup from the DME for $850. The final result was they billed the insurance company $850, the insurance paid $300 and I paid 20% of the $300, or $60. The other $550 was written off by the DME.

The sleep study was even more drastic- they billed $3650, the insurance company paid $1100 and I paid 5% or $55. The rest was written off. Never pay anything until you get the official EOB from the insurance company.

[LSAT]

Hi,
I just experienced a similar issue with Cigna.

Healthline medical is the local equipment I work with to get my supplies. I tell them what I need and in turn they get it approved by Carecentrix (Cigna's medical equipment program administrator) and the equipment is sent to me. It has not always been a smooth process, but generally it worked ok because inside the box with the medical equipment for my CPAP was a Delivery Ticket with an itemization and price listed for each piece of equipment. On its face those documents told me everything I needed to figure out the price I was going to pay. As well, there was a bold section called Insurance and listed there is the name Carecentrix. So, ok no problem Carecentrix works with Cigna the cost on the Delivery Ticket is the price I will pay. Clearly, the delivery ticket is important since it allows me to decide if I want to go into the open market and decide to purchase the equipment on my own and send the equipment back or accept the insurance pricing and keep the equipment.

That was until today when I called Carecentrix because of billing irregularities and found out that the actual bills they'd provided to the insurance company were completely different than the ones Healthline reported on the Delivery Ticket. I calculated that difference to be $397.36 on the Healthline Delivery Ticket and $562.44 as what was reported by Carecentrix to the insurance company, that is a difference of 41.54% that will now be applied against my deductible. I am being told that since the transaction is already done, it cannot be undone so I just pay the cash price.

The strangest thing these guys never thought about is that I then turn around and submit this massive difference to my FSA provider who uses my pre-tax dollars and makes me whole for this inflated deductible amount (that is, the tax I am not paying is being subsidized by the government, in other words, they just screwed the US government).

This is wrong and wreaks of an unclear and unfair process that was devised to defraud the public. Why introduce a third party like Carecentrix into the mix unless you are out to screw people, since clearly they only increased the cost and instead of Cigna having to defend their agent's behavior they blame it on Carecentrix. Carecentrix is clearly Cigna's agent and by that CIgna is defrauding the government through inflated FSA expense. Just beautiful.

It doesn't matter what was submitted to the Ins. Co.....You need to wait until the insurance company pays. They will only pay the price that was pre-negotiated with the DME. This price is much less than the retail price. Your deductible is figured based upon this lower negotiated price.

[SewTired]

That seems fair. I'll just have to cancel the "replacement part subscription": they would keep billing $400 every 6 months for up to 2 replacements of every part (incl. humidifier and mask) during that timeframe. But why would I for example need a new mask every 3 months?!

You definitely want to know what they mean. The usual replacement for a full mask is every 6 months. You can get a new FRAME every 3 months (that's the tough plastic part, not the straps that go around your head). BUT, insurance companies do vary. What a lot of members do is get replacements (backups) of everything during that first year that they've already met their deductible and don't get more until they've met a deductible for other medical stuff. You can get stuff online in the meantime, if you need it.

Be sure to get and keep a copy of your original sleep study (including raw data, not just summary) as well as a copy of your prescription. Invariably, you will need it in the future. Best to get it when it is convenient because most sleep centers appear to store records off-site or simply close up and then you have nothing.

[chunkyfrog]

It baffles me why the frame, which is nearly indestructable, can be replaced 4 times a year,
while the headgear, which often wears out quickly, can only be replaced twice a year.
It is illogical.