Im new to the group and the cpap, ive had mine less than a week. My problem is that no at United Health Care seems to know how much my machine is going to end up costing me. I can't seem to get a straight answer from my DME either. UHC says they'll pay up to 80 percent of anything preapproved, but they have not recieved anything from the DME (I already have the machine and the DME promised that they had already contacted my insurance company). Has anyone else had a problem like this? I guess Im confused because I thought I had preapproval and it seems that I don't.
Help with understanding insurance coverage
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klingonmommy
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klingonmommy
- Posts: 5
- Joined: Wed Jul 25, 2007 12:44 pm
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Too bad you didn't find this group before you took a machine. But that being said her is what I can tell you.
Most Insurance co's rent for a certain time before approving purchase. The humidifier and mask is usually a full purchase when you leave with it. Therefore you probably know what you paid for the humidifier and mask as they probably made you write a check or charge it before you left. And that will be the end of charges for those two items.
You probably also have a rental payment for the machine. Usually the thing is purchased after 3 months of compliance or 10 months or some such time frame. You should be able to tell what your copay was by how much they made you pay when you left with it, and therefore what they are charging your insurance.
If no one has charged you anything yet and you signed some paper taking responsibility for whatever the insurance doesn't cover all bets are off.
The DME should be able to tell you the total purchase price of the machine. Not the billing price, but the purchase price that the insurance co actually will pay and they will accept due to their contract. If they can't or won't it is a crock. Most want to charge somewhere around $1500 for a machine and humidifier. So if that is the case you would pay about $300 plus mask 20%. If you have a low end machine you could likely buy it outright on cpap.com for almost the same money. If you have a better machine, then you could buy it for a little more.
Really get on them and MAKE the tell you what you will owe (or at least what the insurance will pay and you can figure your portion yourself. Would you buy a car and drive it away and not know how much you signed for?
If it is outrageous $$, consider returning it before you get in any deeper and buyiing from cpap.com BUT the humidifier and mask is most likely yours, don't give them back. Consider the make and model if you purchase online don't' just automatically replace the DME's machine as most DMEs give out low end to unsuspecting customers.
Most Insurance co's rent for a certain time before approving purchase. The humidifier and mask is usually a full purchase when you leave with it. Therefore you probably know what you paid for the humidifier and mask as they probably made you write a check or charge it before you left. And that will be the end of charges for those two items.
You probably also have a rental payment for the machine. Usually the thing is purchased after 3 months of compliance or 10 months or some such time frame. You should be able to tell what your copay was by how much they made you pay when you left with it, and therefore what they are charging your insurance.
If no one has charged you anything yet and you signed some paper taking responsibility for whatever the insurance doesn't cover all bets are off.
The DME should be able to tell you the total purchase price of the machine. Not the billing price, but the purchase price that the insurance co actually will pay and they will accept due to their contract. If they can't or won't it is a crock. Most want to charge somewhere around $1500 for a machine and humidifier. So if that is the case you would pay about $300 plus mask 20%. If you have a low end machine you could likely buy it outright on cpap.com for almost the same money. If you have a better machine, then you could buy it for a little more.
Really get on them and MAKE the tell you what you will owe (or at least what the insurance will pay and you can figure your portion yourself. Would you buy a car and drive it away and not know how much you signed for?
If it is outrageous $$, consider returning it before you get in any deeper and buyiing from cpap.com BUT the humidifier and mask is most likely yours, don't give them back. Consider the make and model if you purchase online don't' just automatically replace the DME's machine as most DMEs give out low end to unsuspecting customers.
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klingonmommy
- Posts: 5
- Joined: Wed Jul 25, 2007 12:44 pm
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Guest
Re: Help with understanding insurance coverage
New CPAP users are gullible and sleep-deprived.....and DMEs take advantage of them. They don't do their homework before they sign their names to these contracts.klingonmommy wrote:Im new to the group and the cpap, ive had mine less than a week. My problem is that no at United Health Care seems to know how much my machine is going to end up costing me. I can't seem to get a straight answer from my DME either. UHC says they'll pay up to 80 percent of anything preapproved, but they have not recieved anything from the DME (I already have the machine and the DME promised that they had already contacted my insurance company). Has anyone else had a problem like this? I guess Im confused because I thought I had preapproval and it seems that I don't.
I'll bet if you "do the math", your 20% of the inflated DME price (including deductibles, humidifier, masks, hoses, etc.) is about what you'd pay for the same or better machine from CPAP.COM.
Insurance providers aren't much better......everything's a "secret" with them.
Know what you're (going to be) paying for, before you commit to it.
I see that they gave you the typical "low-end" machine, too.
Den
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Guest
You mean the DME let you walk out of there with a whole CPAP setup without signing your name to anything?klingonmommy wrote:I havent paid anything for the machine yet. Luckily the only paperwork I signed for the machine, only stated I had the option of using other companies for my machine and nothing else. I really wish I would have found this site before I got the machine. All of the information here has been terrific.
Den
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Guest
By "anything", I meant some sort of contract (payments, responsibility if insurance doesn't pay, etc.).Anonymous wrote:You mean the DME let you walk out of there with a whole CPAP setup without signing your name to anything?klingonmommy wrote:I havent paid anything for the machine yet. Luckily the only paperwork I signed for the machine, only stated I had the option of using other companies for my machine and nothing else. I really wish I would have found this site before I got the machine. All of the information here has been terrific.
Den
Den
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klingonmommy
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- Joined: Wed Jul 25, 2007 12:44 pm
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I didnt sign any contracts or anything. I was a bit suprised myself. I expected to put down a deposit and sign a contract at least. But I finally got a hold of someone with a brain at UHC and they say they are going to pay at least 80 percent. So now I guess im just stuck waiting to see what the bill is going to be like from my DME.
Also thanks for the responses, I really appreciate them.
Sam
Also thanks for the responses, I really appreciate them.
Sam
United Healthcare......Depending on what day of the week it is, and what time of the day I call, my sleep doctor is either in or out of network. On every second Tuesday, and the first Monday of the month, the DME I am using is in network, on alternating Thursdays, they are out of network. When I reach a male customer service rep, all bets are off, when I am blessed with a female customer service rep, I am not sure I am even talking with United Healthcare any longer.
Having said that, I was smart enough when I started the whole process to call and get "pre-authorization", and received a "case reference number".
The first time United Healthcare received my claim, they denied it, and said it was a workplace injury and therefor not covered. I then pointed out that a) it was not a workplace injury, and b) they had already paid my sleep doctor, and the hospital that did my sleep study, and c) had also provided me with a preauthorization code for purchasing a cpap.
They then reprocessed my claim and paid as a purchase @ 100% (my benefit level at the time).
See what talking with a girl customer service rep on a Friday after a full eclipse, will do? Worked for me!
Cliff
Having said that, I was smart enough when I started the whole process to call and get "pre-authorization", and received a "case reference number".
The first time United Healthcare received my claim, they denied it, and said it was a workplace injury and therefor not covered. I then pointed out that a) it was not a workplace injury, and b) they had already paid my sleep doctor, and the hospital that did my sleep study, and c) had also provided me with a preauthorization code for purchasing a cpap.
They then reprocessed my claim and paid as a purchase @ 100% (my benefit level at the time).
See what talking with a girl customer service rep on a Friday after a full eclipse, will do? Worked for me!
Cliff
10 posts
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