Yup--I may now be paranoid with DME's

[plr66]

I returned my rent-to-own (a system required by BCBS for 10 months, apparently) M Series CPAP to the DME after the first month, deciding to choke on paying for one out of pocket and out of network, from cpap.com for alot less, considering my horrible deductible now, and again when it is reset in Jan. Most of you might understand the rationale for such a decision. When I saw the bill the DME had sent to BCBS, I was totally blown away last month. Their figure of course was not "allowable" to BCBS, but the billing was made for nearly $500 for that one month. DME filed their bill with BCBS.

I am appalled that BCBS has just sent me a denial for that month's rental. (Yes I have already written an appeal letter and collected every piece of paper I have to document medical need). That is probably worth a whole other thread.

But I swear, as I sit here steaming about it all tonight, fired up from writing a scathing letter to BCBS--I find myself believing that the DME may have intentionally not bothered to send appropriate documentation, and that they will then be able to send that over-priced billing to me. What do you all think? Is that the usual protocol? Or is there a different billing rate for insurance companies and for individuals?

[MichelleFL]

I am so sorry to hear of your troubles and I will be very interested as to what the people in the know have to say here. I am just in the process of getting my prescription and was told from BCBS the very same thing as you, that I have to rent for 10 months. But what they also told me is that at the end of those 10 months they will purchase the machine for me.. Did they not tell you the same? I hope this is settled for you and quickly! Oh and may I ask you, what is the deductible you were paying for the rental??? Thanks!

[nightjar]

$500? Yipes. Did that include the mask? A humidifier? Or was it just the rental for the CPAP itself?

Or does it include tech time--set up, etc.?

Or did you sign a contract for ten months, which BCBS now feels was breached?

This time around I refused to play the games my HMO and DME wanted me to. That's why I checked out cpapauction.com listings, and why I eventually bought a pre-M BiPAP Auto from cpap.com. I'm paying about 50% more than I would have to rent something for six months, but I'll own it. And since we're changing HMOs for next year, renting just didn't make sense. Especially since I own the CPAP I've been using for the last 10.5 years.

And it will be here tomorrow! I'm looking forward to going to sleep tomorrow night.

I will say this for my DME and HMO: at least the machine they wanted to rent me for six months at $77 a month was a good machine--it could have been a M-series BiPAP (Auto or the one just under it) or a ResMed VPAP Auto. Not shabby. But they would have owned the thing.

Anyway, I hope someone can explain those charges to you. It doesn't make sense to me, but neither does much of what insurance companies and DMEs do. I know there are some good ones, and some are good in some ways and not-so-good in others, but still . . . $500 for a month's use of a CPAP?

That's just wacko.

nath

[lovey]

I have Anthem BC/BS, and I received my new bipap on Sept. 29th, 2007. I was required to rent the bipap for 3 months--which made it December 29th. I luckily had met my $4000 out of pocket deductible, when they billed on Dec.29th to own the machine. I would have had to pay a good amount if it had been bought a few days later, and the three month rental ended and the buying of the machine hit in 2008! Stupidity...

Anyways, my DME billed for about $450 a month for the three months, and then $2000 to own on Dec. 29th. They received around $250 rental each month, and then about $1000 to own on December 29th. Every medical provider overcharges at the intitial claim with BC/BS, so that they can get the maximum allowable by BC/BS. It's a big scam, as much of my "billed" charges are paid at 50% by insurance under the BC/BS contract. But heck, if you are an individual, they want you to pay 100% of billed charges. Greedy mother f@@@ing bastards!! What is wrong with our medical system?

[plr66]

$500? Yipes. Did that include the mask? A humidifier? Or was it just the rental for the CPAP itself?
Or does it include tech time--set up, etc.?
Or did you sign a contract for ten months, which BCBS now feels was breached?

......That's just wacko.

nath

Sorry, I should have clarified that the billing was for my M Series CPAP with C-flex and HH as well as a Swift LT mask. That's it. To be fair, the DME would surely need to include their tech time with me, I would think. The DME told me that I was on a month-to-month rental. And they confirmed this even at the time that I said "thanks anyway" upon ending the rental.

My insurance deductible for in-network happens to be $1000. Everybody's is different. But mine was just unworkable for me at this time of year, and since I rarely have any medical issues at all, so that zero had been paid toward that deductible.

But this is not just a rant. I really am wondering if the DME will now be able to bill me for that outrageous amount?

[jules]

bet you got billed for the hose, filters too -- so that is another $50 for the hose and who knows for the filters ---

humidifiers aren't always rentals - sometimes they are purchases the first month - sometimes the little tank inside is purchase now for the m series

masks run probably $250 - $450 with headgear at a DME - maybe more even

machine rental can vary depending on what the expected rental period will be - again this will vary with expected insurance contract they have

[Guest]

wake up - they RENT because they're not sure whether you'll continue USING the thing!
Buy from a legitimate DME.

[Craig-Tx]

$500 / month... That's nothing

I got a M-Series APAP w/ humidifier recently. I'm still waiting to find out what my insurance will consider an "allowable amount" but the DME billed:
for the APAP (NOT humidifier or mask) $700 PER MONTH for 10 months.
for the Humidifier an additional $75 PER MONTH for 10 months.

Yep, that's a total of $7750 if paid in full, for something I can find on the internet for under $700.

In their defense, the hose, filters, and bag that came with the APAP was NOT individually billed.

Yeah, Yeah, they offer services, etc., and should be able to charge more... But really, how much more?

[DreamDiver]

wake up - they RENT because they're not sure whether you'll continue USING the thing!
Buy from a legitimate DME.

Mmm... Thanks guest. With so many legitimate DME's to choose from we have a plethora of options. Right. plr66's experience is not unusual. Please don't marginalize this. And sign in if you're going to make sweeping statements. Otherwise buzz off.

I've said it before and I'll say it again. For those of you who have already started renting since September or October, and have met your deductible for this year - Get your insurance to PAY for the entire machine prior to the end of the year on your insurance. Prove that you have been compliant. Otherwise, starting in January, you'll have to starting paying the deductible on your machine even though you met your deductible for this year. Push this through today. If they won't do this, the rent will likely cost you as much if not more in deductibles next year as you would have paid for a machine you really wanted from cpap.com. Do a spreadsheet comparison with your insurance agent. I'm not talking about calling BCBS or UHC. Talk to the local person who sold you the policy or the human resources person at your firm in charge of figuring out these kinds of charges. They're paid to help you. Use their services. Regardless of what your insurance is paying to the DME, if you find your out of pocket and deductibles are more expensive because of the January restart of deductibles, turn the box back in tomorrow and buy a new one from cpap.com. Do the math so you won't fall prey to what happened to me.

It amazes me how many people get diagnosed in September so they get their machines in October. If I believed in conspiracy theories, I'd say this is one set to help the DME's and Insurance companies wrest more money from patients than from their plans. Just one PSG is often enough to tip people over many insurance companies' deductibles - at the end of the year. Fah. It would be interesting to find out how many people actually end up paying more than the machine is actually worth because of that deductible thing starting again in January. It really makes me wonder if there is a scam going on.

Heed Lovey's warning and talk to your insurance agent today. Don't end up on the short end of this stick.

[rested gal]

The "billed" amount and what the DME expects to get and is perfectly willing to accept from the insurance company is very different. The billed amount can look ridiculously high, but what the DME actually accepts is what they've already contracted with the insurance company that they will "accept" ...and is usually a lot lower than the "billed" amount.

It's preordained, so to speak....from one set of health care gods to another.

[MichelleFL]

I've said it before and I'll say it again. For those of you who have already started renting since September or October, and have met your deductible for this year - Get your insurance to PAY for the entire machine prior to the end of the year on your insurance. Prove that you have been compliant.

Oh my god! Not to hijack this thread but that is exactly what I will have to be doing.. I did meet my deductable for this year but it took me until this sleep study and titration in order to meet it which was in October.. I found out that normal doctor's visits are NOT included in this deductible. Here all along I thought they counted too. So now what do I do?? I have 2 months left in this year even if I do get a prescription of what I want from my doctor on October 30th. How could I prove to BCBS that I have been compliant? And if they won't accept it then how will I pay full price for an overcharged system until I meet my deductable? And if it goes like this year did that will not be until September/October until I meet it.. DANG I hate not having money!! It would be nice to just buy it outright and thank you all for stating this again as I did not catch it the first time it was said... Crap! Now what do I do?? Keep having non breathing episodes for another full year??

[MichelleFL]

Okay another thought... As with most anything in life there is someone, somewhere who can help people in my situation.. By situation I mean poor.. Both my husband and I work full time jobs and we are getting nowhere except for having our hours chopped further and further into part-time if they have there way! No jobs are available anywhere in Florida unless you want part-time and they dump you after Christmas.. *sigh* There has to be some agency, someone who can help with a situation like this. And I bet there are alot of us too! We depend on our insurance as to why we struggle to pay the premiums but it seems that they rip us off at every turn.. What to do?? HELP!

[jules]

michelle - the one program I am aware of is - perhaps others know of other programs - you can also contact your sleep center and DME and ask about charity cases or check a social worker at a local hospital

http://www.awakeinamerica.org/DonateRelief/

look at the "relief" part

[MichelleFL]

Thank you Jules.. I was just looking at the cheapest machines on cpapauction.com and even the older machines are expensive.. Plus if I put all that money into an older machine, how long will it last me? Such choices and even a few hundred dollars would be a great loss to me at this point. I will send in this application now and see if they can help..

[rested gal]

Michelle, that's a good idea to apply at for A.W.A.K.E. assistance in getting a machine. Glad you posted that, Jules!!

Another possibility, Michelle... start asking everyone you run into in your town,

"Do you know anyone who has used a CPAP ("see-pap") machine to help them breathe at night? Not an oxygen machine... a CPAP machine for sleep apnea."

Sooner or later, I'll bet you'll run into someone who says, "Oh, yeah. My brother-in-law (or neighbor or someone!) uses/used one, I think."

Find out how to get in touch with that person, and call 'em up. Ask them if they are still using their CPAP. If they are, congratulate them and wish them well.

But if like so many cpap dropouts, they've stopped using it and are never gonna use it again, explain your plight. I'll bet they'd just give it to you. They'd probably like to clear out the closet or garage space it's taking up.

An especially good place to go hunt-asking might be the congregation of a church, if you attend. If you don't, ask a very active church-goer to inquire on your behalf.

Good luck, Michelle.