Out of Network Auth ~ Help
Out of Network Auth ~ Help
Lincare is being difficult to work with — again. So after waiting a month to get my new cpap "for her" machine (this was after they gave me a used one and tried to pass it off as new) it finally came in on July 14, 2016. When I went to pick up my machine my Lincare RT told me my insurance gives me 30 days to find a mask to "fit" from July 14. Meaning, I could use as many masks as I need till I find one that "fits" and my cut off date is August 14, 2016.
Well, I'm having a heck of a time finding the right mask for different reasons. When I called Lincare on Thursday 8/7/16 the receptionist informed me the RT was on vacation till Tuesday and she was the only person who can help me with a new mask.
At this point I'm annoyed I called my insurance to see if I can get an extension on my 30 days because I haven't found a mask and I keep losing time due to there only being one person in the office who can help me and she's either on vacation or out of the office for the day servicing clients in neighboring towns.
My insurance told me I don’t have a cut off date to find a mask to "fit". So, when the Lincare RT called me today about trying a new mask she reminded me of the cut off time and also informed me Lincare is no longer able to order masks that aren't in stock for clients without a Rx specifying make and model of mask. I asked if the cut off time is specific to my insurance plan and she said "yes" and then I told her I called my insurance last week and they said I don’t have a cut off date to find a mask to "fit". She then said, "well, we go off what Medicare pays, because most insurance pays what they pay."
I'm over it with Lincare and I'm going to try and get an auth to go out of network for DME supplies. My PCP has to call my insurance for the auth, which I'm sure she'll do, but what reason do I give her to give to my insurance for wanting to go out of network?
Thanks
Well, I'm having a heck of a time finding the right mask for different reasons. When I called Lincare on Thursday 8/7/16 the receptionist informed me the RT was on vacation till Tuesday and she was the only person who can help me with a new mask.
At this point I'm annoyed I called my insurance to see if I can get an extension on my 30 days because I haven't found a mask and I keep losing time due to there only being one person in the office who can help me and she's either on vacation or out of the office for the day servicing clients in neighboring towns.
My insurance told me I don’t have a cut off date to find a mask to "fit". So, when the Lincare RT called me today about trying a new mask she reminded me of the cut off time and also informed me Lincare is no longer able to order masks that aren't in stock for clients without a Rx specifying make and model of mask. I asked if the cut off time is specific to my insurance plan and she said "yes" and then I told her I called my insurance last week and they said I don’t have a cut off date to find a mask to "fit". She then said, "well, we go off what Medicare pays, because most insurance pays what they pay."
I'm over it with Lincare and I'm going to try and get an auth to go out of network for DME supplies. My PCP has to call my insurance for the auth, which I'm sure she'll do, but what reason do I give her to give to my insurance for wanting to go out of network?
Thanks
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: I can't find a mask that works for me! |
- Sir NoddinOff
- Posts: 4190
- Joined: Mon May 14, 2012 5:30 pm
- Location: California
Re: Out of Network Auth ~ Help
In the contest between Lincare and Apria to see who can piss off the most clients while delivering the worst customer service, it now appears Lincare (lin.don't.care) may be moving into the lead over Apria (crapria). Stay tuned for the DME Crappy Olympics on a channel near you.
_________________
Mask: AirFit™ F10 Full Face Mask with Headgear |
Additional Comments: Sleepyhead software v.0.9.8.1 Open GL and Encore Pro v2.2. |
I like my ResMed AirFit F10 FFM - reasonably low leaks for my ASV therapy. I'm currently using a PR S1 AutoSV 960P Advanced. I also keep a ResMed S9 Adapt as backup. I use a heated Hibernite hose. Still rockin' with Win 7 by using GWX to stop Win 10.
Re: Out of Network Auth ~ Help
The 30 day mask exchange program is up to the DME. The insurance has nothing to do with it. Some DME's don't even allow the 30 days...
viewtopic/t113085/Testing-a-new-mask.html
viewtopic/t113085/Testing-a-new-mask.html
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion) |
Additional Comments: Back up is a new AS10. |
Re: Out of Network Auth ~ Help
When I called my insurance they said, it was probably something that Lincare imposes. Which is fine, but the RT shouldn't be presenting it as something "my insurance" is doing. Also, this RT has been on vacation twice since July and she's always unavailable due to being out of the office servicing clients. It seems like every time, I ask to try a different mask she saids they don't have it in stock and convinces me to try a mask they do have in stock which doesn't end up working and now she's saying I need a specified Rx to get any masks that aren't in stock.LSAT wrote:The 30 day mask exchange program is up to the DME. The insurance has nothing to do with it. Some DME's don't even allow the 30 days...
viewtopic/t113085/Testing-a-new-mask.html
I'm hoping someone can help me phrase this shit storm of an experience into a valid reason I can give my doctor/insurance for going out of network. Like for example: unable to get equipment in timely manner and it's disrupting therapy. Would that work? Or does it need to be more erroneous than that?
Thanks
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: I can't find a mask that works for me! |
Re: Out of Network Auth ~ Help
You do NOT need a specified prescription to get a mask they do not have in stock. Lincare can order ANY mask you want with your current prescription. But then, that would be extra effort and work for the RT.
Make an appt. with the RT and go in for a fitting. Tell her in advance what particular mask you want to try. Have you gone into their office in person? Also, if you list what masks you have tried and what you don't like about it, we can offer some tips.
Make an appt. with the RT and go in for a fitting. Tell her in advance what particular mask you want to try. Have you gone into their office in person? Also, if you list what masks you have tried and what you don't like about it, we can offer some tips.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: CPAP 10 cmH20., User since 1/1/15. |
Re: Out of Network Auth ~ Help
When my ins. approved me to go out of network, the reason for approval was there was not an In-network provider within so many miles of my house.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: CPAP 10 cmH20., User since 1/1/15. |
Re: Out of Network Auth ~ Help
Experience with Lincare varies by office. My office has been great. I would call the Corporate Regional office and explain the situation. In the meantime, you will have to call your insurance company about out-of-network options. For instance, do they do reimbursement if you go to an online retailer?
SirNoddingoff, Lincare would have to be considerably worse to even approach the vitriol that former Apria customers have spewed.
For your reason for going out of network, you could simply say "availability of staff is too limited."
SirNoddingoff, Lincare would have to be considerably worse to even approach the vitriol that former Apria customers have spewed.
For your reason for going out of network, you could simply say "availability of staff is too limited."
_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Sleepyhead |
Diabetes 2, RLS & bradycardia
Airsense For Her; Settings: range 8-12, Airfit P10 (M)
Airsense For Her; Settings: range 8-12, Airfit P10 (M)
Re: Out of Network Auth ~ Help
I've used Lincare for almost 2 yrs. My local office has a very good RT. The rest of the staff is incompetent at best. I've learned to only deal with the RT. He has even told me to ask for him. When I ordered supplies through the other staff, I either get the wrong items, or the order doesn't even get placed.
Can you try to find the one competent person who works in your local office?
I've also tried to work with Apria, that was impossible. I couldn't get the local office to even return my phone calls to make an appt.
Can you try to find the one competent person who works in your local office?
I've also tried to work with Apria, that was impossible. I couldn't get the local office to even return my phone calls to make an appt.
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: CPAP 10 cmH20., User since 1/1/15. |
- DreamStalker
- Posts: 7509
- Joined: Mon Aug 07, 2006 9:58 am
- Location: Nowhere & Everywhere At Once
Re: Out of Network Auth ~ Help
Why even bother with either the insurance or the DME?
The cost to your health in terms of extended use of an inadequate mask and more importantly, the stress, time, and effort of dealing with that failed system will cost you more in the long run.
Get your masks online (like the forum sponsor).
You could then submit claims to the insurance if you want .... or sell the masks that don't work at a reduced price to help recover your costs .... or just throw them away .... or give them away to make yourself feel better.
People seem to think that because they are offered mental torment or poor choices they must accept it.
The cost to your health in terms of extended use of an inadequate mask and more importantly, the stress, time, and effort of dealing with that failed system will cost you more in the long run.
Get your masks online (like the forum sponsor).
You could then submit claims to the insurance if you want .... or sell the masks that don't work at a reduced price to help recover your costs .... or just throw them away .... or give them away to make yourself feel better.
People seem to think that because they are offered mental torment or poor choices they must accept it.
President-pretender, J. Biden, said "the DNC has built the largest voter fraud organization in US history". Too bad they didn’t build the smartest voter fraud organization and got caught.
Re: Out of Network Auth ~ Help
DreamStalker wrote:Why even bother with either the insurance or the DME?
The cost to your health in terms of extended use of an inadequate mask and more importantly, the stress, time, and effort of dealing with that failed system will cost you more in the long run.
Get your masks online (like the forum sponsor).
You could then submit claims to the insurance if you want .... or sell the masks that don't work at a reduced price to help recover your costs .... or just throw them away .... or give them away to make yourself feel better.
People seem to think that because they are offered mental torment or poor choices they must accept it.
What an unhelpful and rude post. You think that if I could afford to pay out of pocket I would be dealing with this bull shit? Not everyone is in the position to pay out of pocket for these items
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: I can't find a mask that works for me! |
Re: Out of Network Auth ~ Help
There is only one person who can help me at that office, the other people there are the receptionist and the marketing person. But I'm going to try and get an auth for out of network tomorrow with these reasons: limited availability of staff and unavailable supplies in which both are interrupting my cpap therapy.Cardsfan wrote:I've used Lincare for almost 2 yrs. My local office has a very good RT. The rest of the staff is incompetent at best. I've learned to only deal with the RT. He has even told me to ask for him. When I ordered supplies through the other staff, I either get the wrong items, or the order doesn't even get placed.
Can you try to find the one competent person who works in your local office?
I've also tried to work with Apria, that was impossible. I couldn't get the local office to even return my phone calls to make an appt.
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: I can't find a mask that works for me! |
Re: Out of Network Auth ~ Help
I was going to make what I thought was a helpful comment, but, then I remembered that a month ago I did that and you called me rude and a jerk and started calling me bubba. So.... ...to you.cpap82 wrote:DreamStalker wrote:Why even bother with either the insurance or the DME?
The cost to your health in terms of extended use of an inadequate mask and more importantly, the stress, time, and effort of dealing with that failed system will cost you more in the long run.
Get your masks online (like the forum sponsor).
You could then submit claims to the insurance if you want .... or sell the masks that don't work at a reduced price to help recover your costs .... or just throw them away .... or give them away to make yourself feel better.
People seem to think that because they are offered mental torment or poor choices they must accept it.
What an unhelpful and rude post. You think that if I could afford to pay out of pocket I would be dealing with this bull shit? Not everyone is in the position to pay out of pocket for these items
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion) |
Additional Comments: Back up is a new AS10. |
- chunkyfrog
- Posts: 34545
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nowhere special--this year in particular.
Re: Out of Network Auth ~ Help
When my DME refused to order masks I wanted to try, I ordered those masks from cpap.com,
using return insurance to minimize my losses. My insurance (BCBSNE) had such high deductibles
that it was more economical for me to buy ALL my supplies from cpap.com.
It was so nice not to have to WAIT to match the ridiculous insurance schedule to get what I needed.
After some time, my insurance co sent me a letter "reminding" me that I had not been ordering supplies
lately from their PET? Vendor. Can we say KICKBACK?
using return insurance to minimize my losses. My insurance (BCBSNE) had such high deductibles
that it was more economical for me to buy ALL my supplies from cpap.com.
It was so nice not to have to WAIT to match the ridiculous insurance schedule to get what I needed.
After some time, my insurance co sent me a letter "reminding" me that I had not been ordering supplies
lately from their PET? Vendor. Can we say KICKBACK?
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |