My dr. not contracted with DME, so they won't fill his rx?

[TahoeGal]

I got a very rude awakening, finding out my current DME is not contracted with my insurance, and getting a huge bill from them charging me for 6 months of supplies, 1 month rental of o2 concentrater, and overnight oximetry study.

So I called my insurance company, and got only 1 DME that services my area. Apria. My dr sent over my rx, and I didn't hear anything from them. I called after 4 days. I was told that the manager canceled the order, because my dr was not contracted with them!

WTH? Is this for real?

[LSAT]

The DME should have notified you of this when you signed the contract and gave them your insurance information. If this DME is "out of network" for your insurance company, your claim may still be paid but at a lower reimbursement. You haven't indicated where you live or who your insurance company is. I never have heard that a doctor needs to be contracted with a DME. That's BS. A DME should accept a prescription from ANY doctor.

[TahoeGal]

Sorry. I live on the California side of Lake Tahoe, my sleep doc is in Reno (Nevada) about 1 1/2 hours away, the closest place to go for more-than-basic medical needs. They take my insurance, and referred me to DME #1. The dr office sent me to that DME, who was supposed to be contracted with my insurance. This DME is called Bennett medical services. Yes, they suck too. Bennett has offices in California and Colorado and Nevada. The Reno office had been providing the services.

DME #2, who refused to serve me is in grass valley, California. 2 hours from me. That town only provides basic medical services, and it's another hour to get to specialists.

I'll complain to my insurance company- blue shield of California.

[OkyDoky]

Could it be because your RX is from an out of state Doctor? I have heard of some that say they can't take out of state RX. Could you ask your insurance for a in network DME in Nevada?

[Wulfman...]

I got a very rude awakening, finding out my current DME is not contracted with my insurance, and getting a huge bill from them charging me for 6 months of supplies, 1 month rental of o2 concentrater, and overnight oximetry study.

So I called my insurance company, and got only 1 DME that services my area. Apria. My dr sent over my rx, and I didn't hear anything from them. I called after 4 days. I was told that the manager canceled the order, because my dr was not contracted with them!

WTH? Is this for real?

Your post is a little confusing.
I'm wondering how it took you this long to figure this out. You've been on the forum for a couple of years, so I would think you'd have read about others having problems with DMEs and insurance........and to check with insurance on these things before you commit to them.

So........is Apria the one who sent you a huge bill or is that someone else?


Den

.

[SewTired]

I can't help you on anything else, but you should know that HIPPA laws are being misunderstood and many medical suppliers do not contact patients, even ones they have scripts for. You are expected to contact them (your doctor is supposed to tell you who to contact).

[Goofproof]

It seems your ducks are all facing different directions, you may need a ear of corn, to get then lined up and marching together. Jim

[TahoeGal]

It seems your ducks are all facing different directions, you may need a ear of corn, to get then lined up and marching together. Jim

I like that one. With it being Halloween, maybe it should be candy corn? A big bag of it?

For several big reasons, my life has been difficult this year. I have a little breathing room until December, when I have another surgery. I'm trying to tie up loose ends. The timing of the bill is "good " since I have some time to deal with it.

DME #1 is Bennett, who provided services to me, and did not disclose to me that they're out of network. I totally agree that I failed to do my homework on using this DME. I'm sharing the blame with Bennett on this one.

DME #2 is Apria. They are in network. I initiated the contact with them. My sleep dr faxed my rx to them last Monday. Apria did not contact me, so I called them Friday and was told that the manager cancelled my order for a O2 concentrater and an oximetry. They said they would not provide services to me, because they (Apria in Grass Valley) don't have a contact with my sleep doc. It was not because blue shield denied the request for services, or that the rx was from Nevada.

I don't understand why Apria won't "fill" my doc's prescription. Seeing that it is not a s.o.p., I will call blue shield and make a complaint. Given that this is my first experience with Apria in Grass Valley, I don't want to work with them at all. Period.

[Goofproof]

I can't see a reason for a doctor to be contracted with a ins provider, I think they are giving you cow pies. The DME needs to be contracted with the INS, not the DR. The DR. needs to be Licenced to practice medicine in the USA, that should enough, he needs to get a better answer as to why you don't need what he ordered. Jim

[mariejeanne]

If your insurance won't give you a satisfactory response, tell them you are going to file a complaint with your state's insurance board. If that doesn't work, file the complaint.

[TahoeGal]

I just spent over an hour on the phone with my insurance company. Here's the update.

#1- my insurance company is paying the old, out of contract DME the full amount of the bill. You could have knocked me over with a feather! I don't have to pay those bills. Never, ever thought an insurance company would volunteer to pay for something they didn't have to, according to my policy Limits. I never even asked for an exception.

#2- the insurance representative looked for a DME in my area, and only found Apria was contracted. She said that they couldn't refuse to fill the rx. She recommended I purchase a unit from an in network DME. That it will save me a lot of money, if I buy this year I won't have a copayment. I agree on this. My plan was to rent to the end of December, then buy. I want to follow my dr's orders to titrate my O2 according to overnight oximetry reports, to make sure the O2 concentrater can handle the LPM needed to keep my O2 up. I did order a recording spo2 device to do it myself- screw the DME 's!

[idamtnboy]

DME #1 is Bennett, who provided services to me, and did not disclose to me that they're out of network. I totally agree that I failed to do my homework on using this DME. I'm sharing the blame with Bennett on this one.

Bennett is in Idaho also, and I think Utah. I switched to them after my previous DME, a small local outfit called CPAPNow, lost out on the Medicare competitive bidding process. I have not been impressed with them at all so your problem with them does not surprise me one bit. I don't know about their non-Medicare business but they turned over, or sold, their Medicare business to Verus Healthcare, formerly CPAP Care Club. I have not been happy with them either. I will be switching to Norco which is both a DME and industrial gas and welding supplier in the Northwest. I had heard they weren't that great but my first stop there was good. Otherwise my only other choices are Crapria and Lin-don't-care.

Hopefully CPAPNow can make it in the next bidding cycle.

[TahoeGal]

Good luck!

I'm working on buying my own. Insurance will cover a rental, but not the purchase. I'm going to try to talk sense into them. Never know, it might work.

[idamtnboy]

Good luck!

I'm working on buying my own. Insurance will cover a rental, but not the purchase. I'm going to try to talk sense into them. Never know, it might work.

There's a good possibility that if you rent it for a year it becomes yours. That's the way it works for DME like your CPAP machine. Insurance pays the rent for 12 or 13 months and then it's yours as it has been paid for completely.

[TahoeGal]

I heard about that here. Unfortunately they don't do that. My old insurance, anthem, would not do it with my vpap. They wanted over $400 per month for it. So I bought the damn thing outright (4K for just the blower. Had to buy from DME. I didn't know about second wind). My new insurance, blue shield of California also won't "buy" the unit. I hit my max copayment for the year, so I can rent now at no charge to me, if i want to deal with crapria.