Is this Medicare Fraud?

[hootenanny]

I called Humana and they said they'd look into it more and get back to me in a week.

They are my Medicare Advantage Plan and a bunch of other things like tubing etc were billed out separately. Here are screenshots of the bills.

Just because Humana is not Original Medicare, because they are Part C I believe that comes with several strings attached.

I think I am beginning to understand that the line item for the nose pillows includes the mask frame. So the $14.63 includes the three nose pillows (only got one) and the frame that the nose pillow attaches to. The elastic headgear strap is a separate charge.

The grievance states... "Our Provider Relations department spoke with ? and she stated that they only billed you for one, which is for the five cushions. ? stated during your initial visit on 12/29/2021 they did a fit pap on you to know the correct fitting. They stated they did not charge you for this service. She stated that on 12/30/2021 they mailed you the five cushions."

So like the most recent poster said, it's not fraud just the way things are done but we'll see what Humana has to say in a week.

https://drive.google.com/file/d/1iQYuLs ... sp=sharing
https://drive.google.com/file/d/1e0ehJx ... sp=sharing

[zonker]

this entire thread makes me VERY grateful that i don't depend on medicare in any form to be able to buy my machine and supplies.

having said that, i'm fully aware of just how lucky i am. not everyone can do the same as me.

[dataq1]

I called Humana and they said they'd look into …

Is this your bill from the DME ???

[ChicagoGranny]

this entire thread makes me VERY grateful that i don't depend on medicare in any form to be able to buy my machine and supplies.

Gramps and I have Medicare Advantage plans and they work very well. Private purchase from an internet DME is always more expensive.

[SleepGeek]

The fit pack is just as mentioned designed that way so the user can find the correct size to wear.

IMO the message here is that it is time for you to find another DME - they will continue to do this shyster type of business and you (and others) are feeding their habit.

Ask Humana who else is in your network and get the list in case you need to change again.

I called Humana and they said they'd look into it more and get back to me in a week.

They are my Medicare Advantage Plan and a bunch of other things like tubing etc were billed out separately. Here are screenshots of the bills.

Just because Humana is not Original Medicare, because they are Part C I believe that comes with several strings attached.

I think I am beginning to understand that the line item for the nose pillows includes the mask frame. So the $14.63 includes the three nose pillows (only got one) and the frame that the nose pillow attaches to. The elastic headgear strap is a separate charge.

The grievance states... "Our Provider Relations department spoke with ? and she stated that they only billed you for one, which is for the five cushions. ? stated during your initial visit on 12/29/2021 they did a fit pap on you to know the correct fitting. They stated they did not charge you for this service. She stated that on 12/30/2021 they mailed you the five cushions."

So like the most recent poster said, it's not fraud just the way things are done but we'll see what Humana has to say in a week.

https://drive.google.com/file/d/1iQYuLs ... sp=sharing
https://drive.google.com/file/d/1e0ehJx ... sp=sharing

[poppi2]

When this scenario happened to me, I told the DME rep that I preferred that my supplies remain hermetically sealed in original packages. I joked I didn’t know how sanitary the hands were, that moved the pillows to the little “druggie” zip-lock baggies.

[chunkyfrog]

Most of my pillows come inside the resmed tearaway bags--
Then I remove them to a "druggie" bag--so it will fit in my storage.
First mask during Covid--they left sealed, so I did get all the pillows--
as if I can use them! I'd rather they got sold than wasted.
The fit pack is never used by Medicare for pricing,
but DMEs can order masks any way they like.