Lincare "Ethics" (irony in quotes)

[Dreamingofsleep]

Hi caffeinated,

I had Lincare the first time I tried CPAP. I live in Wyoming. When I gave up after six weeks, signed the AMA and returned the machine, my insurance and I were billed for purchasing the machine! I was also billed for masks I tried and was told I would not be charged for.

I placed many, many calls to their billing office, talking to supervisors who supposedly straightened out the bill. It is a year later and they are still at it!

Dreaming

[NateS]

What I most object to is that they are not honoring the agreement we had when I started, namely that I would own the device after 12 rental payments.

If you made an "agreement" then it is in writing, right? Where is your copy? It is essential to file all your medical documents and papers in a place you can find them and, better yet, also scan them onto your hard disk before filing them. If you can't find your copy, your first letter should be a simple request sent to them by certified mail, asking them to mail you copies of all documents regarding your medical care, as required by HIPPA, including all paperwork regarding the acquisition of your machine, its accessories and supplies. And don't tell them them what your issue is or what you are looking for in the paperwork until you have it all in hand. Once you have the paperwork in front of you, you will be standing on firmer ground and likely save yourself a lot of aggravation and grief.

I'm not trying to pick on you but to simply stress a cardinal rule which must apply to all of us. Any time you are asked to sign papers, read them and make sure whatever you were told and assured of is clearly written in the written agreement, do not accept any verbal assurances that are not in writing, and do not leave without a copy of the signed agreement - that is, a copy with your signature on it.

Regards, Nate

[Drowsy Dancer]

Nate:

One point that I rarely see addressed is that my ownership of my machine (and most likely many others' ownership) is actually governed by three contracts:

(1) The contract between my husband's employer and Aetna, our group health insurance carrier;
(2) The contract between myself and Apria, my DME, AND
(3) A contract between Aetna and Apria, which was incorporated by reference into contract #2

I don't know anyone who's been able to get their hands on #3. I was successful in having those terms as they related to my CPAP purchase described to me once, but I don't have a hard copy.

[NateS]

Nate:

One point that I rarely see addressed is that my ownership of my machine (and most likely many others' ownership) is actually governed by three contracts:

(1) The contract between my husband's employer and Aetna, our group health insurance carrier;
(2) The contract between myself and Apria, my DME, AND
(3) A contract between Aetna and Apria, which was incorporated by reference into contract #2

I don't know anyone who's been able to get their hands on #3. I was successful in having those terms as they related to my CPAP purchase described to me once, but I don't have a hard copy.

Drowsy, If (2) merely refers to (3) as, for example if you are acknowledging the fact that some services, products, etc. are being provided by one upon behalf of the other, then you may not be entitled to a copy; but if (2), a contract to which your agreement was required, actually uses the term "incorporated by reference" when referring to (3) as containing terms to which you have agreed, then most certainly you are entitled to a copy. If the latter, I would suggest sending a certified letter requesting same to Aetna and to Apria.

Regards, Nate

[chunkyfrog]

Access to agreements #3 should be automatic.
The decisions made in closed sessions may mean life or death.

[Drowsy Dancer]

Hang on.

For those of you with insurance coverage:

Do you think your insurance companies do not have contracts with your DMEs? Do any of you have a copy of that contract?

For those on Medicare, do you have a copy of your DMEs contract with Medicare?

[SethW]

Seth -

1) I would get crystal clear on your insurance policy regarding purchase of a CPAP device. If they will reimburse towards outright purchase then go for it.

2) Get a copy of your CPAP prescription from your doctor. Then you can buy from whomever YOU choose.

Lincare varies by local agency in two ways: (a) they do not know what they are talking about, or (b) they are dirty fraudsters. Take your pick. I made sure the machine they gave me was brand new and will buy it since I've researched the price and found it fair.

If I find myself in need of purchasing another machine, I am just going to buy it. If insurance pays for some part of it, great, but given my deductibles, that probably isn't going to happen no matter what I do.

Nate:

One point that I rarely see addressed is that my ownership of my machine (and most likely many others' ownership) is actually governed by three contracts:

(1) The contract between my husband's employer and Aetna, our group health insurance carrier;
(2) The contract between myself and Apria, my DME, AND
(3) A contract between Aetna and Apria, which was incorporated by reference into contract #2

I don't know anyone who's been able to get their hands on #3. I was successful in having those terms as they related to my CPAP purchase described to me once, but I don't have a hard copy.

Drowsy, If (2) merely refers to (3) as, for example if you are acknowledging the fact that some services, products, etc. are being provided by one upon behalf of the other, then you may not be entitled to a copy; but if (2), a contract to which your agreement was required, actually uses the term "incorporated by reference" when referring to (3) as containing terms to which you have agreed, then most certainly you are entitled to a copy. If the latter, I would suggest sending a certified letter requesting same to Aetna and to Apria.

Regards, Nate

What Drowsy is saying about #3 has certainly been my experience with Lincare. They have refused all my requests for more information. And your reaction of sending certified letters is where I'm at now.

[Kenwood]

This just made me laugh last night when I looked at the DME invoice from US Med....they had to order my Aloha mask from our hosts - CPAP.com I'm going to wait and see what my insurance company does with this invoice and how they reduce it down. I haven't opened anything. I pay 50%, so I can just ship it back to US Med and order direct from CPAP.com if my co-pay is more than that.

[caffeinatedcfo]

Just to update for newbies - Lincare is STILL over-billing me because they only processed some of the adjustments they advised on 5/2/13. They also DID NOT submit these corrections to my insurance carrier. I'm taking my complaints to the next level and have filed a grievance with my health plan carrier.

If you are new to CPAP - Stay Away from Lincare!

[herefishy]

Don't you think all the Medical Costs are ridiculous? I think all things medical are billed at outrageous prices, that's why you can't get an itemized bill from a hospital.

[caffeinatedcfo]

Don't you think all the Medical Costs are ridiculous? I think all things medical are billed at outrageous prices, that's why you can't get an itemized bill from a hospital.

Yeah but I understand that they have to do that due to Medicare regulations. Medicare uses a lower of cost of charge rule when reviewing reimbursement to providers. If their gross charges are less than their costs then Medicare takes money back. All I care about is what they keep wasting my time with - BILLING FRAUD. Yes, I said fraud. Medicare defines billing fraud as making the same billing mistake twice. Plus, these fools knew it was wrong when I called the first time, but failed to correct it. I even filed a grievance / fraud claim with my insurance company to ensure it gets proper attention for timely follow-up.

The whole US health care system is corrupt like everything else the government touches. What ever happened to the concept of laissez-faire economics? We learned this in Economics 101, didn't our elected legislative officials?

Sorry - gotta stop or I'll go on a tear of our corrupted economic policies.

[caffeinatedcfo]

So to wrap up Lincare's ethics for those considering choosing them as their DME:

Today I received a call back from my 5/31 billing complaints. Not from the supervisor that was supposed to, but from the biller that I originally spoke with on 5/2. He stated he couldn't adjust off the humidifier amount (was billed as purchase v. rental), because my insurance ha already paid. I reminded him that (1) yes he could do this still, and (2) we spoke on 5/2 but insurance didn't even receive the original claim until 5/28. He stated I was being difficult and in the end it really didn't matter because I had to pay the balance of the full 50% at the end of 3 months rental (my insurance pays 50% and Lincare deducts rent paid from my 50% share). I stressed again that he did not follow through on what he said he would do and that I confirmed three times during our 5/2 phone call that he was adjusting that billing to a rental. He then offered to finance the purchase and I finally lost my cool and let him have it.

After hanging up with him, I called his supervisor and let her know what was going on. She apologized 900 times and did offer to fix it. Since I already know I want to own this equipment, I had already decided to put my behind me and stick with the purchase, but I did make her adjust the rent and purchase amounts to the amounts per my insurance-issued EOBs. Yes, Lincare bills their customers BEFORE even verifying your true responsibility!

[DarrylM]

I am so new to this. Given this discussion I am (1) wondering what are the most important supplies to have in back-up given that I certainly do not want to face a night without my CPAP therapy if I can avoid that and (2) if I use CPAP.COM or my DME can I find out beforehand what I should expect to pay for this or that by calling my insurance company? Is that what I should do?

[caffeinatedcfo]

I am so new to this. Given this discussion I am (1) wondering what are the most important supplies to have in back-up given that I certainly do not want to face a night without my CPAP therapy if I can avoid that

I would say:

• mask cushion
• headgear
• SD Card
• Filter

I didn't list hoses because they could be temporarily taped up while waiting for a replacement.

and (2) if I use CPAP.COM or my DME can I find out beforehand what I should expect to pay for this or that by calling my insurance company? Is that what I should do?

YES! Definitely call your insurance company first - BEFORE you choose or meet with DME. CPAP.COM may not accept your insurance so you may be like me and get your machine (exactly the machine you want!) from a DME, then use CPAP.COM (or another source) for supplies. Some DMEs are pretty good I've heard, but it is location specific.

[dizzybluebaby]

My husband was diagnosed about a month ago. He went for 2 sleep studies-the initial diagnostic, and later, the one that measured how much pressure he needs to open his airway (18, btw). Went to the sleep doc (good god-is she another story...), and she sent his script for the equipment to Lincare 4 days ago. We live in a dinky little city in the Mohawk Valley of NY, and the only 2 DME's available are Lincare and another outfit that has even worse reviews...I am beyond furious at this point. They sent the script to the doc last Wednesday morning....when I heard nothing from them, I called later in the afternoon. The woman that answered said she had the script, but gosh, she was just swamped with paperwork, but she would put my husband's on the "top of the list". Great. Thursday came-no call. Friday came-no call. I called them again late Friday afternoon. Seems they had the time to get the insurance ok'd, but gee whiz...the woman who does the "fittings" only does them on Thursdays, and "she should be getting in touch with your husband early next week to schedule something". One day??? She does them ONE day a week?? What the heck does she do the rest of the time? Blood pressure starting to sky rocket...but ok, fine...however, now it's Monday, and no call from them today either. I will be calling my insurance company tomorrow morning, to find out exactly what they are covering, etc-thank you for the heads up on that one from the other posters. Then I will call these incompetents at Lincare AGAIN, and this time I know I am not going to be able to keep my cool-I've had it. I am so disgusted that I may have to use these idiots that I am ready to tear my hair out. I am hoping and praying that our insurance (FEP Blue) allows us to buy online with reimbursement. Even without, it would be cheaper in the long run, according to all the calculations I've made. I just detest the thought of giving my money to these crooks at Lincare.