Is this out of line?

[sleepmba]

For home studies, Medicare pays about $200. If you pay cash out of your own pocket for one, it's about $300. Something fishy is going on with your situation. If that Doc's office won't work with you, I'm sure your insurance company would like to know the details. Intuition tells me if the Doc's office doesn't correct that mistake....it could be considered insurance fraud. Please keep us updated.

[jonquiljo]

Yes, I intend to get on their bad side if I find anything wrong. I am terribly angered whenever I see medical establishments ripping consumers off. I am one of the lucky ones that can deal with their nonsense - but many people can't. And that will not change for a long while.

I don't like bad medicine either. An old family friend of my wife died recently - basically could have lived much much longer if their doctor did not ignore them because they were "older" and let a bad situation get fatal. And this was at one of the best medical centers in the US. This too was unacceptable.

[imtired]

My at home sleep test cost me $150, i was told i could have gone to a sleep lab for $800. my insurance didn't cover any of it so that was the full amount. Location must have a big part of the price, or i just found a good dme

[Gia]

I got my bill yesterday. This is after paying $300 up front because I had not meet my $500 deductible.

Total Charges: $4,119.30 Payments Adjustments: $4,110.35 Balance Due: $8.95

I can't believe my insurance paid that much.

I doubt if your insurance paid that much. Most providers wil use the term 'payment Adjustments' to mean both the actual dollars paid, and the contractual write-off amount. Some providers will split the line items so you can see what the actual payment is, and others will combine them since they do not want cash customers to see how much (or how little) the insurance companies pay (and it is stil profitable for the provders).

You can check you insurance EOB - most carriers will now tell you the actual dollar amount paid since in a lot of states that is the amount that goes towards your OOP and lifetime maximums.

[waynegs]

Wow. I am glad I found a good sleep center / DME.

I paid $875 for my study and got my s9 elite with swift fx mask and a hose cover for $900.

[LinkC]

the sleep titration alone was billed for $5,034.01 (have no idea what the penny was for.)

The penny was to cover their actual costs...

[Mimmie]

Since I have had cpap machines before I knew I could get one anywhere - especially since my insurance would never pay for it.

Where do you find a new unit for sale without a doctor's Rx? The ones I've seen online say they need one, though the masks don't seem to.

You can get all your equipment on Amazon without any scripts and even updraft machines for asthma.

[jmcd]

I just had a sleep study done a couple of weeks ago. They billed my insurance $3,800 but the insurance company's contracted rate with the provider was $800. My insurance covers that at 90% and I owed $80.00. Seems like all medical providers bill unbelievably high rates even though they're submitting the claim to an insurer. They also cover 90% of my CPAP rental. Can't complain about that!

[stephanie13724]

that should be the "billable" charge if it was a Type 1 test (which is an in lab test). That seems ridiculously high for a home study. (btw - I'm the clinical coordinator for a sleep disorders center in a hospital in texas. we are looking into offering home testing but haven't done it yet because the reimburesemnt is SO much lower than a standard test, etc). Was this the bill or an explaination of benefits from your insurance company? Did they file your insurance company??

[jonquiljo]

Was this the bill or an explaination of benefits from your insurance company? Did they file your insurance company??

I got the EOB and it had the code for an "in house" sleep study. I called the sleep center, and they claim that the billing company they used "made a mistake", though the girl at the sleep center I spoke to was surprised that the billing company made a mistake because she said her submission to them had been clearly marked with the code for a take home machine and that it was also marked "customer self pay - $200".

What I think happened was that the billing center did make a mistake, and the sleep center was not at fault. But it pays to read your EOB statements!

The sleep center told me that the billing company handles all payments as well. I wonder if there is something shifty going on, or are they just that stupid. Given that I have to pay $5K a month for insurance for my wife and myself - I am really sensitive to being over-billed or ripped off by any medical company.