DME/Insurance snafu, I have to pay for it!

[Komodo]

I get a bill in the mail from Apria. (everyones "favorite" DME )
They say I owe them $14 for filters from my last supply order.
My insurance pays 100% on my supplies, so I shouldn't have any out-of-pocket expenses.

I call Apria to see if they made a mistake sending me a bill. They tell me my insurance paid for the rest of the order, but NOT the filters, and I was responseable to pay the $14, and then take it up wiith my insurance company on my own to get reimbursed.

I call my insurance company to find out what happened and why they didn't pay for the filters.
They tell me, Apria requested the pre-approval for the other supplies on the order, but didn't include the filters on the request. Since they didn't get the request for pre-approval for the filters, they're not paying for them. I asked if Apria could get a retroactive approval, and they just laughed at me and said no. (hey, I tried!)
I gotta pay!

I call Apria again, tell them it's THEIR FAULT they didn't get paid for the filters, and basically they told me "Too bad, So sad, you still gotta pay!"

This burns my butt!!!
Please correct me if I'm wrong, but as far as I know, your DME is the one who is supposed to get the approval for any supplies you order from them BEFORE they send them out. If THEY send you supplies without the approval, even if you're the one who ordered it, "To bad, so sad" for THEM, they should have to pay for their mistake, NOT me!

I haven't paid the $14 yet. I wanted to hear your opinions on my situation first. Should I fight them on it? ~OR~ Pay the money and get on with my life?

[LSAT]

Tell them that you will pay the $14, but will be transfering to a different DME for future supplies. I'll bet they shape up quickly.....If they don't... make the change.

[Madalot]

I haven't paid the $14 yet. I wanted to hear your opinions on my situation first. Should I fight them on it? ~OR~ Pay the money and get on with my life?

Well, if you like them and want to keep working with them, I might pay it, but if they were worried about customer service, they would have eaten it without billing you for it. They knew they were supposed to get pre-approval on ALL the supplies and they messed up.

On the other hand, it's only $14 so it depends on whether it's worth it to YOU to put up a fight. I can be pretty stubborn when it comes to things like this, so I might dig my heels in if I felt like fighting it, but it would depend on my overall relationship with them.

My wheelchair DME screwed up BIG time on an upgrade to my powerchair and ATE $1500 because they screwed up. They TRIED to make me pay for it, but backed down IMMEDIATELY when I pointed out why they didn't get paid for it.

[bwexler]

I am in the same boat with Apria. In May I ordered some supplies from Apria, when I picked them up they asked if I also wanted a new water tank for my h5i humidifier. Since mine was 2.5 years old I said OK and took it. Now they have decided to bill me for it, also about $14. I think this may be a little like the "do you want fries with that", knowing that many people will just pay rather than fight. Now that I have read your story I suggest we both follow up one more time with our insurance and then tell Apria it is between them and the insurance company.

In my case they have just provided a new PRS 1 DS 960 ASV machine on a very lucrative perpetual rental agreement, where the rent pays the full value of the machine every 9 months. Since I have no copayment on the rental, but a 20% copayment on anything over $500, I am in a tough place. Apria quoted me $12,000 as the price they would base my copayment even though the online price is $3,000.
In the open enrollment meeting with my insurance company I pointed this out to the COO of the company. He just brushed it off as they will provide service on the rental equipment. He obviously has never dealt with Apria as a customer. They are my ONLY in network DME so I am stuck with them unless I want to pay.

[BlackSpinner]

Send the filters back and tell them you will be ordering filters from somewhere else from now on.

[jwerley]

Send the filters back and tell them you will be ordering filters from somewhere else from now on.

This is what I was told, don't know if it is true: If the OP is on Medicare you cannot do that and get them paid for. You have to get your supplies from your contracted DME.

Janice

[BlackSpinner]

Send the filters back and tell them you will be ordering filters from somewhere else from now on.

This is what I was told, don't know if it is true: If the OP is on Medicare you cannot do that and get them paid for. You have to get your supplies from your contracted DME.

Janice

They can still send them back and tell them to re-order them properly. This is not the service they contracted for.

[Bobshouse]

I would return the filters. I know it's only 14 dollars, but, hey, sometimes you have to stick to your guns.

I'm wondering if any of these people have billed insurance for services NOT rendered? How would you know if they claimed you ordered a new hose or a replacement humidifier chamber? I don't receive any notifications from my health insurance provider for any bills paid.

[Jeannh]

File an appeal with your insurance co, detailing your experience with their contracted DME provider, who is not providing their contracted service. Copy the DME, your local BBB, and state insurance regulator.

[StuUnderPressure]

I'm wondering if any of these people have billed insurance for services NOT rendered? How would you know if they claimed you ordered a new hose or a replacement humidifier chamber? I don't receive any notifications from my health insurance provider for any bills paid.

I ALWAYS receive a statement of EVERYTHING that was paid by both Medicare & my BC/BS secondary. And, I DO review them for accuracy.

I would believe that insurance has paid for services not renedered.
But, I believe that is because people just don't bother to review those statements.

I am not saying that you ARE receiving those notifications.
Just seems strange to me that you are not.

[chunkyfrog]

I would return the filters, and tell then you will not authorize shipment until they have run it through again
with all their hoops jumped through first. To avoid that, they could eat the $14, and keep your business.

[ems]

Tell them that you will pay the $14, but will be transfering to a different DME for future supplies. I'll bet they shape up quickly.....If they don't... make the change.

Exactly.

[Sir NoddinOff]

I would return the filters, and tell then you will not authorize shipment until they have run it through again
with all their hoops jumped through first. To avoid that, they could eat the $14, and keep your business.

This autumn, I was worried about this pre-approval issue when I asked Apria to supply me with a Wisp Fit Pack (BTW, not cheap), therefore I questioned my customer rep about being able to return the contested product to them completely UNOPENED. They said once it's delivered to my house, unopened or not, it's a done deal and I couldn't return the item to get my account zero'd or to cancel the bill. What a rip off. The sad part is that Apria is aware that lots of people loathe them and they have made some positive strides in the last year to create better customer relations.... then they do this kind of stuff Yes, my Wisp arrived quickly and so far I've not gotten a bill from Apria.

[Komodo]

Tell them that you will pay the $14, but will be transfering to a different DME for future supplies. I'll bet they shape up quickly.....If they don't... make the change.

That's exactly what I did with my LAST DME over a $24 bill!

I fought them for MONTHS over the bill before switching to Apria.

My insurance only has two in network DME's for me to choose from. The other one is WORSE than Apria, so it looks like I'm stuck with them.

Send the filters back and tell them you will be ordering filters from somewhere else from now on.

I would, BUT.....this bill is from an order I placed 3 months ago, and the filters have already been used.

I ALWAYS receive a statement of EVERYTHING that was paid by both Medicare & my BC/BS secondary. And, I DO review them for accuracy.

I would believe that insurance has paid for services not renedered.
But, I believe that is because people just don't bother to review those statements.

I am not saying that you ARE receiving those notifications.
Just seems strange to me that you are not.

I do get an EOB from my insurance showing what they paid for, but their codes don't match up with the codes for the items I ordered. I check the number of items ordered, and the price my insurance paid, to see what's going on.

FILTERS have rarely shown up on my EOB, both for Arpia, and my last DME. Never received a bill for them before, and assumed they caught THEIR mistake of not getting approval and "ate" the cost themselves.

[Jeannh]

I do get an EOB from my insurance showing what they paid for,

Some insurance (UHC, for example), don't send an EOB if there is no member responsibility due them. This will be true for HMOs or copay-only plans. Saves them tons in printing, paper and postage.