Insurance procedure code

[mpetershat]

I have Blue Cross. According one DME in town the compliance code of E0601 they have cannot get me a ResMed S9 AutoSet decked out that I want. The doctor has prescribed an Auto. Does anybody know the compliance code that will? I have paid my out of pocket for they year.

I have a 2nd DME working on it too.

[ronbien]

As far as I know these are the codes for CPAP and BiPAP machines.
E0601 Continuous airway pressure (CPAP) device (e.g. smart CPAP, auto CPAP, CPAP)
E0470 Bilevel
E0471 Bilevel with backup rate

Yours seems to be E0601 as far as I can tell.
Good Luck!

[cowlypso]

The code for a CPAP and an auto machine is the exact same code. Your DME is either ignorant or lying. Insurance pays the same amount for that code regardless of what machine you get, so many DMEs will steer you toward a straight CPAP (cheaper) so they make a larger profit. A lot of them will claim that they cannot give you an auto machine unless your doctor specifically prescribes it (which is a lie). But that lie is easier to get around if you have a doctor who is willing to write the prescription.

It's really weird that the DME is being so insistent. Plus, even if it was billed under a different code, if your doctor prescribed the auto, then they should give you the auto.

[Slinky]

Who is it who keeps telling us if it is night time and the DME tells you it is dark out, go outside to check for yourself??? Or sometime to that effect. Either these DME providers are being less than truthful or they are ignorant as ole billy heck. Given there's about $50 extra out of their pocket for the APAP ... take your choice which of the above is the logical and most likely answer.

[apneawho]

E0601 is the code for both cpap and auto cpap machines. Someone doesn't know what they are talking about or they are trying to muddy the waters and deceive you.

[MidnightOwl]

I think what the DME supplier is saying is that they WILL NOT provide it. And they may be entirely within their rights to say that. Unless their contract with the payor (insurer) says differently they don't have to provide all possible machines. Whether or not it's a good business decision to alienate your doctor is another matter but that's also their decision.

[chunkyfrog]

Don't let them sell you an S9 Escape Auto--Only S9 Autoset will give full functionality and data.
If this DME will not play ball, find one who will.
They may be within their rights, but you have rights too.
Take your money someplace else!

[RandyJ]

What the DME means is that since all E0601 cpaps and apaps get reimbursed at one fixed price through insurance, they want to give you the cheapest machine they can to maximize their profit. They want you, all of us actually, to believe that we are only entitled to the bottom of the barrel for the insurance premiums that we pay.

Since Resmeds are more expensive and they don't give discounts, that may be why they don't want to get it for you. They will probably offer a different auto that they can save $$ on.

If you insist on the machine that you want, they may indicate that they can help you if you pay an upcharge -- $100, $200 etc to them, in addition to whatever your insurance pays. In many states the practice of balance billing is illegal, but since they are giving you a premium item that you are not otherwise entitled to (in their opinion), they get away with it and call it a co-payment. Participating in this is entirely your choice.

If you call around, you may find a DME to give you the machine you want at the insurance reimbursement rate... but it may require a lot of calling and depending where you live, you may have to travel to do it.

Good luck.

[Lizistired]

I'd be shopping for a new DME. And tell them you are going to call around and find a DME that will give you what you want. A couple of days won't make a difference.

[Janknitz]

Read "what you need to know before you meet your DME" in my blog link below.

Call your insurer to verify that coverage is for any E0601, and ask them if they permit DMEs to practice balance biling (charging you more for certain E0601 machines).

[chunkyfrog]

After retirement I am considering road trips for equipment (50+ miles)
because only one provider in Lincoln accepts medicare assignment.
I wonder if there's a travel agent who books cpap shopping trips--like the casino 'tours'.

[Slinky]

Dream on, Chunky, dream on.

Come on, 50 miles is only one hour each way. Make a fun shopping trip outta it. Special luncheon date, etc.

[apneawho]

Chunky, sounds like you might be the person for the job! You could probably organize the tour and make some profit.