I spent today going back and forth between the DME and BCBS-Federal on converting my rental to a purchase (there was nothing else to do with a blizzard raging outside). What an education! I spent a lot of time on hold as the person helping me at BCBS was seeking help from a higher power. They assured me that content of our conversation is recorded for future reference (I just may need that). I know that no two insurance companies are the same and I am sure that if someone were to call BCBS they would no doubt get a different story.
Here is what I found from each today:
1. The DME is charging the insurance $2300 for the machine and the humidifier!
2. BCBS said that they would only pay what comes out to be a little over $1,000 (45% of the DME charge).
3. I checked the BCBS statement figures for the first month’s rental and they are exactly 10% of the above totals.
4. BCBS allows rentals for up to 10 months, after which the equipment is purchased. (If I did nothing I would be renting for 10 months).
5. BCBS policy is to require renting for the first month. After that, the patient can request purchase. (All the DME has to do is put “new unit for purchase” on the 1120 form).
6. The DME failed to return my call for the purchase info I obtained from BCBS. When I did get hold of them, I found that they had processed not only my November rental but had also prepared my Dec rental billings today! (They sent my Oct rental to BCBS around the first of Dec). So, my first call today on what they were charging and converting to a purchase apparently prompted them to get the rental paperwork moving quick before I could get the purchase info back to them.
7. DME agreed to pull the above billings and process the form for purchase.
It paid for me to ask questions and persist in the purchase. I wish I could say that I have faith in the DME following through but I have not had any luck in working with them at all. Phone calls were not returned, I had to continue to call to get a response from them, they lose my compliance records for the Dr. and I end up providing it to him and now the billing situation. I honestly thought I had a great DME initially when they drove out to set me up. It is as if their responsibility ended when the drove away.
Hope this info is helpful to some. It was never clear to me how this all worked out when reading the postings. It is as if there is some secret formula that cannot be divulged. I ended up more confused. Perhaps it was because of the different insurance plans and DME practices. I'm sure that there will be postings that will contradict what I have posted here. That is fine with me. I just want to divest myself of my DME and renting and get on with my life. Well, as of today this is what I was told is the way to convert a rental to a purchase….tell the DME you want to purchase and make it so.
How to purchase a rental
3 posts
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It looks to me that my DME is charging BCBS 295.00 per month for ten months for a Respironics Auto Bipap. I actually pay 16.48 per month (my coinsurance). Now, the purchase price for this unit is around 1200-1300 outright. I intent to propose to BCBS that I just purchase the unit on-line. Seems to me that both BC and I would save money.
The DME tells me that they charge that much to the insurance companies because they (the DMEs) can, and BCBS doesn't care.
Problem is that my BCBS insurance only managing the medical expenses for my self-insured employer. Consequently, my employer is the one that is carrying the overcharge to provide a obscene profit margin for the DME.
When I ask my employer about this, their reply is "our hands are tied", no matter what "insurance" carrier they use, they all do the same thing.
Sounds fishy to me.
The DME tells me that they charge that much to the insurance companies because they (the DMEs) can, and BCBS doesn't care.
Problem is that my BCBS insurance only managing the medical expenses for my self-insured employer. Consequently, my employer is the one that is carrying the overcharge to provide a obscene profit margin for the DME.
When I ask my employer about this, their reply is "our hands are tied", no matter what "insurance" carrier they use, they all do the same thing.
Sounds fishy to me.
_________________
| Machine: AirSense 11 Autoset |
| Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear |
| Humidifier: DreamStation Heated Humidifier |
Dataq1
I have the same situation but not BCBS who is contracted to provide for the selfinsured employer.
My company couldn't possibly care less about how much money they are wasting and I appealed the decision 3 levels of management.
Go for it but don't be disappointed when you lose. Maybe someday some of these companies will get the idea.
I have the same situation but not BCBS who is contracted to provide for the selfinsured employer.
My company couldn't possibly care less about how much money they are wasting and I appealed the decision 3 levels of management.
Go for it but don't be disappointed when you lose. Maybe someday some of these companies will get the idea.
3 posts
• Page 1 of 1