Calling the insurance company tomorrow, need advice

[Tekcor1]

Tomorrow I'm going to try and exchange my S9 Escape Plus for a data-capable S9 Autoset. After reading the blog post "Help, I'm stuck with a brick!" it suggests calling my insurance company first to be sure they cover ANY E0601 machine, whether it's data capable or not, CPAP or auto.

My question is, do I need to explain that I was given a non-data capable machine and that I want to exchange it, or do I just call and ask "Do you cover any cpap that Lincare can supply?" I have double insurance, Regence is my primary and Aetna is my secondary. Do I also need to call both insurance companies? I would presume I do in order to be covered by both.

I know my machine right now is a rental, and needs to be for 3 months before converting to a purchase. I assume that the first month will count toward the rental even though I'm (hopefully) changing machines? I guess this is probably a question I should ask the DME tomorrow. I'm hoping so because I've already met my deductible for the year and if this month counts then it should convert right before the new year. Note to self: call a few days before the new year to ensure it has converted to a purchase.

[Janknitz]

Your insurer probably doesn't give a flip about which machine you have, whether or not it has efficacy data. Or if you like it or not. All you need to ask is:
1. Do they cover all E0601 machines or only specific models?
2. May a DME charge you more for one type of E0601 over another (in insurance-speak "may the DME practice balance billing")?
3. Which vendors may you use?

Don't expect any sympathy or help from your insurer--they don't care!

[Tekcor1]

Thanks Janknitz! Having specific questions to ask will definitely help me to make sure I have my bases covered. I'll report back tomorrow how I fared.

Was that your blog post that I referenced? If so I'd like to extend a huge thank you! It's great having such succinct information available when you need it. As soon as I realized that I had a compliance-data only machine and needed the other kind I thought I was sunk. That blog post gave me some hope and A plan of action. If it wasn't you, perhaps someone can offer the name of the person I should be thanking.

[Tekcor1]

Update. I called the insurance company today and was told that there are no exclusions to what cpap they cover, as long as it is obtained from an in-network provider. I then went to my DME appointment that I had originally made to swap out my mask. I have decided to stay with my mask (pillows) for a few more days because I'm not having as much of an issue with mouth breathing as I thought I would, at least not for now.

I told the DME that I decided to stay with my mask but instead would like to swap out for a different machine, one that recorded data. He stated that this one did in fact record data. I told him that I wanted one that recorded effacy data, not just compliance data (yes, I felt very smart using that line). I then told him I was interested in getting the S9 Autoset. He replied that they don't usually give that one to people, so they had none in stock. I told him that was fine, I could use this one for awhile until they were able to order in an Autoset.

He then replied that he would need to check to see whether my insurance covered that machine, and asked what insurance I had. I told him that my primary was Regence and secondary with Aetna. I then said that I had just gotten off the phone with Regence and they did in fact cover this machine. With his sails somewhat deflated, he left the room for a couple minutes and when he returned, told me that he would order "it" and give me a call as soon as it came in. I confirmed once again that it was the S9 Autoset that he was ordering, and he said it was. I thanked him and left the offce.

Thanks again for all the advice this forum has to offer. I have used the Escape for the last two nights but have absolutely no idea if it's working or not without data. I'm looking forward to getting the Autoset!

[MidnightOwl]

Thanks again for all the advice this forum has to offer. I have used the Escape for the last two nights but have absolutely no idea if it's working or not without data. I'm looking forward to getting the Autoset!

How do you feel? It's a good place to start.

Congratulations.

[archangle]

Bravo! Now wait for the callback to tell you that it would be illegal to give you an Auto machine because your prescription is for a fixed pressure. Or that your insurance won't pay, etc.

Look and become familiar with where it says "Escape" on your machine. Be sure it says "AutoSet", not "Escape Auto" when you get the new one.

[Janknitz]

WAY TO GO!!!!!

The next call from your will be to tell you how much more you will have to pay for the "upgraded" machine--but you already know how to handle that one, too! Poor DME probably doesn't know what hit him!

[GumbyCT]

He replied that they don't usually give that one to people, so they had none in stock.

That is another stall tactic. That is like a gas station being out of gas.

You have them on the ropes but they will try other things like the upgrade fee. Hope you discussed that with your insurance too. Should also make contact with your doc cuz they may also say your script is the problem.

[Tekcor1]

WAY TO GO!!!!!

The next call from your will be to tell you how much more you will have to pay for the "upgraded" machine--but you already know how to handle that one, too! Poor DME probably doesn't know what hit him!

Yep, already asked that when I called the insurance company the first time. Was told that as long as the provider is in-network they can't balance bill. And you're right, the "poor" DME probably doesn't know what hit him!

He replied that they don't usually give that one to people, so they had none in stock.

That is another stall tactic. That is like a gas station being out of gas.

You have them on the ropes but they will try other things like the upgrade fee. Hope you discussed that with your insurance too. Should also make contact with your doc cuz they may also say your script is the problem.

Yep, seemed a little odd to me since they had tons of different equipment lying around. I told them I was happy to wait though to get the machine I wanted. If they do call back saying my script is the problem, my PCP will have no problem writing a script that will state the exact machine I want.

Thanks again everyone for the advice!

[msradar65]

I would cut them off at the pass. I would call you doc and have him write out script for Resmed S9 autoset. Make sure you keep a copy of the script.

[GumbyCT]

I would cut them off at the pass. I would call you doc and have him write out script for Resmed S9 autoset. Make sure you keep a copy of the script.

Not a bad idea. Hold on to it, then hand deliver it so they can't play the "didn't get the fax game". Oh the games DME's play.

Be sure to keep a copy for yourself.

[archangle]

I would cut them off at the pass. I would call you doc and have him write out script for Resmed S9 autoset. Make sure you keep a copy of the script.

If you do this, be sure it says "AutoSet", not just "Auto".

And specify a pressure range, even if it's fairly narrow.

[xenablue]

Oh my!! I SOOO love this forum.

Good luck Tekcor1!!! Can't wait for the next episode!

Cheers,
xena

[Tekcor1]

An update to the story. I called them on Tuesday on last week and was told that they had ordered the AutoSet machine, but that they had to get "approval" from the main office before it could be shipped out. This was two weeks after they had told me that they had ordered it originally. I told them that I wasn't going to wait forever for the AutoSet and that if they couldn't supply it I had already found another DME that said they would supply it. I told them they had until the end of the week to get it or I would be in to return the Escape. Of course, the manager was "out of the office" but the person I spoke to assured me they would pass it along.

I called back on Wednesday to speak to the manager but she was again out of the office. I recieved a call on Thursday telling me my AutoSet had come in. Pretty quick considering the main office supposedly hadn't even approved it on Tuesday. I picked up my AutoSet yesterday (it was really an AutoSet) and I also got a Climateline hose while I was there. I also got some different pillows for my mask since I was having some issues with leaking.

I used the machine for the first time last night. I used the new, larger pillows and had much more leakage than before so I'm going to go back to the smaller pillows tonight. I haven't had a chance to look at my numbers from last night, but I'm excited to check them out tomorrow.

I just wanted to come on and say thanks again to everyone on this forum. Without your help I wouldn't have gotten a machine that I can see how much it's helping me. I encourage anyone else that gets stuck with a brick to follow the advice here and get it swapped out!

[apneawho]

Congrats Teckcor. Well done.