Arrgh. Stupid insurance rant

ehusen · Post by **ehusen** » Wed Jul 13, 2005 7:41 am

Okay, so let me say first that I'm just complaining and it's partially my fault. (Then some questions at the end so my post isn't a total waste of space...)

So I got to the company my Doctor recommended to get my machine. They say they have to verify that my insurance company will work with them and if not they will send me to another company who will. (This should have been my first clue that something was going to be messed up. But I thought, "kudos to them for making sure")

Well, they do turn out to be "covered" by my insurance (Humana PPO in Illinois). What I didn't realize (and should have, that's where my mistake comes in) is that they are "out of plan" and so the "coverage" is much less. i.e. 70% with a 400$ deductible vs. 90% with no deductible. So my out of pocket is about 500$ and could be a bit more depending on what they are billing to the insurance. Grrrrr. Heck at those prices I almost can just buy the dang thing myself.. (Plus there is one charge on there that the insurance company didn't pay becuase it exceeds the allowable charge for that item. So far, the vendor has not charged me for it, but that could wind up costing me another 350$!)

Note to self, never ever accept anything from providers until you verify exactly what the cost will be before hand..

Oh well, now for the questions. (I know the right thing to do is just call my insurance company to find these out but thought people here might have some general info.)

Any idea on how often you can purchase masks/tubing/accessories/etc.? How often does one get to purchase a new xPAP machine? Or are these very specific to a given insurance? Are there DMEs/vendors that are actually in the "plan"? (and thus I could get the 90% coverage with no deductible)

Since I've now covered the deductable, I figure I would like to try and buy a spare mask for my machine this year before it resets again.

Sigh, I've certainly learned that "Knowledge is Power" now. Every time I've dealt with insurance issues and not had the complete information, I've pretty much gotten screwed... Thanks for letting my vent. As always, at this point, I try to be stoical. I got an okay machine and a mask I can use and I seem to be able to, usually, get to sleep with it on. And while the little 500-800$ surprise charge is painful, I can manage to pay it without losing my house or anything.

Later,

Eric

loonlvr · Post by **loonlvr** » Wed Jul 13, 2005 9:49 am

Well, I would raise holy heck with the DME. I d go in there with equipment and tell them that THEY screwed up not informing you that they weren't part of your insurance plan. I'm very sure your insurance told them that. I would return the equipment and go to another DME or have them cover the difference which they might do... Also tell your insurance company first what your doing. I suppose this shows we need a list of all DME s that are part of our coverage Before we buy anything.This DME needs to be taught a lesson.

Severeena · Post by **Severeena** » Wed Jul 13, 2005 11:35 am

I always do DME research on my own.

I call the insurance company and tell them what I need and looking for and they help me with it.

I have never had problems with the insurance company helping me.

Guest · Post by **Guest** » Wed Jul 13, 2005 12:01 pm

Severeena wrote:I always do DME research on my own.

I call the insurance company and tell them what I need and looking for and they help me with it.

I have never had problems with the insurance company helping me.

Yup, exactly. I learned that lesson a while back with my daughter's premature birth and subsequnet 10 week stay in neo-natal ICU. Even then, my insurance company didn' t always know the answer. (One time they even said just let them bill it and see what happens. Hunh? Just don't worry about possibly owing thousands of dollars?!???) Guess I just was all caught up in other issues like heart conditions and recently being diagnosed with this whole OSA thing. I always verify the doctors and hospitals but I just assumed (wrongly) that this place was in the plan since my doctor referred me. (He may get an earful the next appt. with me...)

Guess I'm just a little bummed that these places don't at least make an attempt to let you know how much you might have to pay. Of course then, they would have lost my business and I would have gone elsewhere. (Of course, they've lost my business now, but that's after the fact)

I guess I could go yell and scream at them but I'm not good at confrontations. Plus, it was my mistake (technically) not verifying the cost before hand (even though I felt a bit mislead by them with the "make sure the insurance will work with them spiel)

I will probably just include a semi stern letter with my check stating that while I find the service/product acceptable the out of pocket cost was much higher than expected and made me pretty unhappy. As a result I will no longer be doing business with them. It will probably get thrown out without even being read but it will make me feel better.

Eric

Severeena · Post by **Severeena** » Wed Jul 13, 2005 6:25 pm

I know what you mean.

It is time for my new face mask from Medicare and guess what. Not one of my DME's handle my mask. DAAAAAA is there a problem here? I even asked my DME if he could get my mask I need, guess what. The purchasing people will not get in the mask for me.

GEESH.

I cannot order on line because I have no CC's and I found my mask for a very good price. I wish the company had an insurance section, this would really help a lot of us.

I am going to ask my SA doctor to see who he can recommend to get my mask from.

chrisp · Post by **chrisp** » Wed Jul 13, 2005 6:38 pm

Severena, Look at the top right of this page...Medicare CPAP patients..

Click it... http://www.cpapforseniors.com/

Chris

Severeena · Post by **Severeena** » Wed Jul 13, 2005 6:50 pm

I have already tried cpapfor seniors and they do no handle that mask.

chrisp · Post by **chrisp** » Wed Jul 13, 2005 7:01 pm

what mask is it ?

Severeena · Post by **Severeena** » Wed Jul 13, 2005 7:39 pm

It is the Hans Rudolph.

No, one wants to handle this mask for some reason, I find it is very comfortable to me and once I can get the proper sized mask, I will be in dream land rather quickly.

I have found the mask online, but local DME's are not wanting to handle this mask. They want to push company names they know and maybe 70% out of 100% of the people can wear this mask. I think something is wrong when you have figures like that staring you in the face.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

stetsongirl · Post by **stetsongirl** » Sat Jul 16, 2005 5:47 am

I do the insurance verifications for a DME company, and I agree wholeheartedly with loonlvr.

Im2tired · Post by **Im2tired** » Sat Jul 16, 2005 9:28 am

My doctors office wanted me to use an out of net-work vendor and they told me that this DME would only charge me what the in-network would (10%). I thought about it and it's not just the 10% vs. 30%, I'm close to my $1500 out of pocket for the year and out-of-network does not count for that. Plus United Health Care has negotiate prices with in-network DME's so their cost is lower and subsequently, my cost is lower since it's 10% of the negotiated price. I think it's harder to research DME's than doctors. Often you can't tell by the name what type of equipment they sell and almost always the customer service reps at the insurance company don't know anything more than what you can find on the internet. I went through this craziness with my first insulin pump. They couldn't tell me who was in net-work or how much it would cost me. I had to have the pump companies submit to them to find out. Luckily there are not as many pump companies so it wasn't as involved.

I was wondering too how often you can get new equipment. With the insulin pump usually you can get a new one when the warranty is up or if your dr. can justify that you need additional features. But some companies will only do it when the old one breaks. The CPAP DME told me that insurance would only allow me a new mask every 6 months but that it would be changing to every 3 months. I started having trouble with my Comfort gel leaking air this week. I called about getting something else and at 1st they said no but then said since it was within 30 days I could. Actually it's been 5 weeks so I don't know what they will do. Also am working on switching to Auto. My insurance rents the machine for 2 months and then buys it so I don't own the one I have right now.

stetsongirl · Post by **stetsongirl** » Sat Jul 16, 2005 12:57 pm

Most insurance company follow Medicare guidelines which are:
mask every 3 months
nasal pillows 1/month
headgear every 6 months
tubing every 6 months
disposable filters 2/month
nondisposable filters 1/6 month

Severeena · Post by **Severeena** » Sat Jul 16, 2005 7:32 pm

The trouble is the 3 months is up and I cannot stand nor wear the mask that was forced on me.

The Full Face Hans Rudolph is the most comfortable.

I need a local DME that can order this mask for me.

I guess I am going to have to go back to the idiots that didn't know how to size me and have them order the three month HR, since it was to soon for the insurance company to order it.

gracie97 · Post by **gracie97** » Mon Jul 18, 2005 1:04 am

This probably doesn't have much to do with what is going on in this thread, but it is a RANT:

On Tuesday have to go back to the sleep lab for three week check in. This provider has so far been insistent that I ONLY get equipment, including interfaces, through him.

His prices are atrocious. ($1700 for a RemStar Pro 2!)
And his behavior and that of his staff is...well, the opposite of sharing power and information.

So guess I'm going to have to leave the RemStar I'm renting from him there and bid him adieu at this next appointment. The time has come to admit that I just won't pay his prices.

I really dislike that I have to have that unpleasant confrontation.

And even more than that I hate to have to interrupt my CPAP treatment until I can get another doctor to prescribe for me!

I feel bitter that he's put me in a position that I'm forced to either temporarily discontinue treatment and find another provider or be fleeced badly: It seems very unethical!

Severeena · Post by **Severeena** » Tue Jul 19, 2005 2:51 am

Gracie97, I would write the medical board of your state about your doctor.

Second the Better Business Bureau likes to know about DME's that practice unethical business dealings as well.

I personally have turned DME's and doctors in.

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Arrgh. Stupid insurance rant

Arrgh. Stupid insurance rant

stupid insurance rant

Arrgh. Stupid insurance rant