My insurance paid what?!!!

[Guest]

I got a Remstar Plus M Series a couple of months ago. (I'm not having any real problems using it.) My question is about the cost. To make a long story short, my insurance reimbursed them over $1700.00 and my out-of-pocket part came to $198.00 for a total of nearly $1900.00. I am finding websites where the identical machine is available for $480.00 plus the cost of the mask. Is this kind of payment by an insurance company typical???

[WearyOne]

I got a Remstar Plus M Series a couple of months ago. (I'm not having any real problems using it.) My question is about the cost. To make a long story short, my insurance reimbursed them over $1700.00 and my out-of-pocket part came to $198.00 for a total of nearly $1900.00. I am finding websites where the identical machine is available for $480.00 plus the cost of the mask. Is this kind of payment by an insurance company typical???

Are you looking at what your insurance company was BILLED, or what they actually PAID? Sometimes there can be a big difference. Looking at an EOB from your insurance company or your account online will show what they actually paid the company for the machine.

For example, my DME billed my insurance company $155 a month for 10 months for my machine for a total of $1550. I paid nothing. But, because of the contract my insurance company has with my DME, the insurance company only paid the DME $43 a month for 10 months for a total of $430. Even though the DME billed them $1550, they only received $430 for the machine. (M Series Pro). Now, if I went in and tried to buy one outright, then I'd get socked with the ridiculous $1550! Also, if I had a different insurance company, it's very possible those amounts would be different because the DME could have different contracted amounts for every insurance company they deal with.

Pam

[Wulfman]

I got a Remstar Plus M Series a couple of months ago. (I'm not having any real problems using it.) My question is about the cost. To make a long story short, my insurance reimbursed them over $1700.00 and my out-of-pocket part came to $198.00 for a total of nearly $1900.00. I am finding websites where the identical machine is available for $480.00 plus the cost of the mask. Is this kind of payment by an insurance company typical???

Maybe....maybe not. Did you get a statement from your insurance provider showing what was billed and what was actually paid?
Many times insurance providers negotiate with "whomever" for lesser amounts than they get billed for. So, even if the DME billed them $10,000.00.....they'd only get $1000.00 (just for an example).

Many of us worked it out with our insurance providers to have them reimburse us for these items so we could purchase them online and save everybody a pile of dough.

But, yeah, even if the insurance negotiated lesser amounts, they (and you) still got screwed......because it was more than what the online prices are.

Den

[lwg]

The figures I quoted were what the insurance actually paid. The amount billed was even higher.

[Wulfman]

Goes to show you how "smart" the insurance providers are at spending YOUR premium dollars.

Welcome to the forum!


Den