Wait what?? I just saw my medical explanation on benefits!

[mzlaura1884]

Techmed charged my insurance on 8.17 same date of my appointment first $100
and then also the same day $832.04 in which my insurance paid
$34.75 out of the $100 and it says i owe $8.69
then we have
$832.04 and my insurance paid $320.68 and it says i owe $80.17

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet. Why is techmed billing my insurance full amounts already if they said my insurance changed their minds to a "rental" am i missing something here? My insurance was billed already not even after a full month and it says i owe money but i haven't gotten a bill yet? I am lost!

[greatunclebill]

for best results pay what your insurance says to pay. they are the ones that decide what you pay & they don't consider your thoughts. if the dme bills something different, refer them to the insurance.

[SleepDepraved2]

Techmed charged my insurance on 8.17 same date of my appointment first $100
and then also the same day $832.04 in which my insurance paid
$34.75 out of the $100 and it says i owe $8.69
then we have
$832.04 and my insurance paid $320.68 and it says i owe $80.17

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet. Why is techmed billing my insurance full amounts already if they said my insurance changed their minds to a "rental" am i missing something here? My insurance was billed already not even after a full month and it says i owe money but i haven't gotten a bill yet? I am lost!

On the first bill, your insurance had not paid on the $832.04 yet. So the second billing of $832.04 shows that your insurance paid $320.68. This is probably 80% of what they consider "reasonable". You get to pay the other 20% of the reasonable charge. Techmed eats the rest.

It's teh same with the $100 (probably your mask?) which the insurance again only pays a portion of the reasonable charge and you get the other portion, with the DME eating the rest.

[mzlaura1884]

Techmed charged my insurance on 8.17 same date of my appointment first $100
and then also the same day $832.04 in which my insurance paid
$34.75 out of the $100 and it says i owe $8.69
then we have
$832.04 and my insurance paid $320.68 and it says i owe $80.17

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet. Why is techmed billing my insurance full amounts already if they said my insurance changed their minds to a "rental" am i missing something here? My insurance was billed already not even after a full month and it says i owe money but i haven't gotten a bill yet? I am lost!

On the first bill, your insurance had not paid on the $832.04 yet. So the second billing of $832.04 shows that your insurance paid $320.68. This is probably 80% of what they consider "reasonable". You get to pay the other 20% of the reasonable charge. Techmed eats the rest.

It's teh same with the $100 (probably your mask?) which the insurance again only pays a portion of the reasonable charge and you get the other portion, with the DME eating the rest.

haha no wonder they get "pissed off at their profit from my FULLY DATA capable machine" lol
So i haven't gotten a bill yet who do i pay???

[mzlaura1884]

Also even though the machine was technically "paid for" if i pay my full 20% for everything now does it become a sale? I mean the insurance already paid their part so i don't understand why this still maintains a rental?

[chunkyfrog]

Get your insurance to put it in writing.
Then send a copy by REGISTERED MAIL to the DME.
'cc' to your doctor as well, and the applicable medical regulators.
Do not talk to them in person. Wait until they get their act together.

[Janknitz]

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet.

Never, never, never, never, NEVER trust a DME to tell you what your insurance will cover or not or how they will cover it. ALWAYS confirm with your insurer. Most insurers don't "change their mind" about things like a sale vs. rental. The DME may prefer a rental because perhaps they get more in the long run (I don't know if this is true, just a guess), so they may just tell you the insurer "wants" it that way.

Get the information from your insurer, hopefully in writing. THEN figure out what's going on with the DME.

[mzlaura1884]

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet.

Never, never, never, never, NEVER trust a DME to tell you what your insurance will cover or not or how they will cover it. ALWAYS confirm with your insurer. Most insurers don't "change their mind" about things like a sale vs. rental. The DME may prefer a rental because perhaps they get more in the long run (I don't know if this is true, just a guess), so they may just tell you the insurer "wants" it that way.

Get the information from your insurer, hopefully in writing. THEN figure out what's going on with the DME.

Oh my uhgggg i hope i didn't get taken for a ride! The RT at the DME even told me to call the insurance to see why they changed their minds so i guess to just assume since everything went well that day to trust them! The only explanations i can come up with is
1. YES the DME is the one who preferred the "rental"
and
2. The insurance paid fully for it but wants month by month compliance for 10 months and if they don't get it they will take the money back they already paid and make me fully responsible for all costs?

I will be calling the insurance company tomorrow. But i wanted to ask the experts first if this sounded right? Is it possible the DME was not lying and my insurance turned in back into a sale? I am sooo confused!

[Pugsy]

Sometimes the humidifier is considered an up front purchase one time thing but the blower machine is considered under the rental part of things. Humidifiers aren't normally considered returnable items but blowers are. Doesn't make a lot of sense but that is the way it is done sometimes.

[brucifer]

Techmed charged my insurance on 8.17 same date of my appointment first $100
and then also the same day $832.04 in which my insurance paid
$34.75 out of the $100 and it says i owe $8.69
then we have
$832.04 and my insurance paid $320.68 and it says i owe $80.17

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet. Why is techmed billing my insurance full amounts already if they said my insurance changed their minds to a "rental" am i missing something here? My insurance was billed already not even after a full month and it says i owe money but i haven't gotten a bill yet? I am lost!

Laura, take a look at the agreement you signed when you took possession of your Autoset, mask, and supplies. Does it say "rental" or "sale"? Whatever you agreed to in writing is what governs the transaction. That's where you will find your answer.

IF your DME supplier pulled a fast one, and you signed a rental agreement when you thought you were signing a sales agreement, then you need to call your insurance company and DEMAND a sale, not a rental. The insurance companies get screwed on the rental arraingments as well, so your insurer may very well agree with you that a sale is better. My insurer is CIGNA, and their CS rep told me that they do not rent CPAP machines. They only authorize outright purchases. They also do not track compliance like some other insurers do such as Medicare.

Best of luck!

[MidnightOwl]

Techmed told me this was a rental on a month by month basis after the insurance initially agreed to a sale. I've not even had my machine a full month yet.

Never, never, never, never, NEVER trust a DME to tell you what your insurance will cover or not or how they will cover it. ALWAYS confirm with your insurer. Most insurers don't "change their mind" about things like a sale vs. rental. The DME may prefer a rental because perhaps they get more in the long run (I don't know if this is true, just a guess), so they may just tell you the insurer "wants" it that way.

Get the information from your insurer, hopefully in writing. THEN figure out what's going on with the DME.

Never, never, never trust an insurance company customer service rep to give you the correct information about what they will pay for and how. And unfortunately there is no good way to confirm what they say except by trial and error. You can try to check your employers actual contract with the insurer but if it's not spelled out there - good luck.

DME's don't get more for rentals - the rental payments are credited against the purchase price. It's never going to be in their interest to delay getting paid for equipment they've already provided. At least that's how it worked when I got my machine and I haven't seen anything in the years since to suggest the system
has changed.


mzlaura,
Do you have the actual eob in hand? Are there any code numbers next to the charges?

To me it sounds like a rental. Those numbers (about $440) don't sound high enough to be a purchase to me. What is sounds like is the purchase of mask, humidifier, and all those other goodies like the hose at the negotiated price, plus a months rental on the cpap.

I think my DME billed as sale even though they knew it was a rental. It confused me no end at the time but I eventually figured it out. They'd bill the full price, the insurer would ignore that a pay the rental amount, then the next month they'd bill the full price again (less first rental payment) and again the insurer would just pay the rental. . The third month they billed the remaining amount of the purchase price and the insurer paid it all. One month earlier than I'd been told to expect. It's probably easier for them to do it that way and it guarantees that they get paid off the minute the insurer is willing to do it. It did make for some very confusing statements and bills to me and therefore a delay in getting their check from me.

You only need to pay the amount shown on the insurance company's eob. You can wait to get a bill to pay it if you want. You should however understand exactly what you are paying for. If it's not clear from the eob than call the insurer up and make them go thru it line by line.

[purple]

What I know, and how I know it. For What It Is Worth.

Most insurance companies, at least partially follow the Medicare rules. Medicare does not pay outright for the entire machine, but does a 13 month rental to own. Sometimes this can be invisible to the consumer, if you have an insurer who pays the whole price. I have traditional Medicare only, no one to help with premiums, deductibles or co-pays. If I got a new machine from my DME, would have a monthly co-payment for 13 months. Strangely the first several co-pays are larger than the rest. Your situation is likely to be some variation on this. The insurer is trying to limit their loss if the patient does not "Meet Compliance." Likewise to some insurers, "Compliance" means you must meet with whoever is in charge of your sleep therapy at certain specific intervals, and they will stop payments for the machine, or masks, hoses, filters, if you do not meet the insurers compliance rules.

I have also found, as you might, those I speak with at the local DME know nothing about what you I owe, should pay, when or what the rules are. All money things are handled by another division of their company, and those at the local DME I commonly speak with really do not know anything. That is not what their job is. The job of those whom I speak to at the DME have the job to help the patient, and they are supposed to do that until their computer screens have a block placed on them by accounting, and they still might find a way to help you.

In my experience, the receptionist barely knows the name of the stuff. A receptionist is supposed to help get you to the next line of people. Sometimes a DME will give you the name of a specific person to speak with every time you call. That level of person should be able to help advise about leaks, help you find a new mask and so on. In my case, I also have recurring supplies, masks, filters, sent to me from a central warehouse, another group of people I speak with represents the local Warehouse. The Central Warehouse never sends out anything until the date which Medicare says it should be provided, unless the item is damaged, or I pay for it. Like I had a hose rip open, they just sent a new hose, No Charge. My local DME guys have provided items at no charge, which the warehouse would never sent out. A different mask, so on.

Behind the agent at my local DME office, (and I speak to several different ones) who handles my requests, the company also employs a Certified Respiratory Therapist. RT's have a lot of schooling, experience. I have to hold my tendency to mouth off and try to say what I say in questions, rather than trying to tell the RT about things they know more about than I ever will. If I listen, I get the opportunity to learn a lot. I do not much deal with the RT anymore, it is not, in my view necessary for my treatment. I know where in their organization to ask which type of question.

Some DME's pay so low, with high employee turnover, that they tend to have a lot of people who do not know squat about what they are talking about. The part of their group which has, do not know, seems to be the part which does the money part. Keep good records on all your money transactions with them. Not that the money billing taking part of their organization will ever let you find an error in their billing, but they might credit your payment to someone else's account. You can ask, they certainly make mistakes. The rules regarding who pays what, when, are in a constant state of flux for all the medical and insurance systems. I now see special rules that are created to make me pay more than the usual co-pay in other parts of health care. My local hospital had itself declared to be not a hospital, but a Critical Care Facility, so now I have a bill in which Medicare was to pay like less than $1700, and I was to pay over $1500.00. The usual formula is that Medicare pays 80 percent and I pay 20 percent. Now, I am expecting all kinds of odd rules for Sleep Treatment as well. The good news is that while I owe the DME a lot of past bills, accounting has never told the other part of the DME not to provide me items, or advice.

My point is, the receptionist is not paid to know how to keep a mask from chafing, or help you get a different size mask, (well not usually, sometimes a receptionist can be a bit of a level two person as well). You will not need to speak only with an RT every time you call. DME's do not pay a lot of money to a very competent, qualified specialist to sit by the phone and wait for your call. Just to make the RT available in a reasonable time frame when you need them.

Being armed with good information is good. If you have not read it: http://maskarrayed.wordpress.com/what-y ... me-part-i/

I still advocate trying first to be as non-confrontational as possible with DME employees, recognizing that DME employees are not very well paid, and a little civility, humor goes a long way to getting them to be helpful to you in the long run. But being aware of what you need, and still being willing to ask the questions you need to have answered is necessary.

In a slightly different vein, I now notice that as I am now 62, people are beginning to think they can order me around, like telling an elementary school student what to do, when. Those people are like staff in a medical office. They can be downright irritating, and it is becoming more difficult for me to respond in a kind way. Children. What can one do with children who misbehave?

[chunkyfrog]

Put them in 'time-out'.
I now have two DME's in 'time-out'.
They may suspect it, but as long as I make 'nice', they can't be sure.
I just say I'm satisfying my deductible online, but the stuff online is so inexpensive,
I never reach my deductible. Odd! How do you suppose the DME's make a living?
I could care less . . .

[Guest]

Oh my uhgggg i hope i didn't get taken for a ride! The RT at the DME even told me to call the insurance to see why they changed their minds so i guess to just assume since everything went well that day to trust them! The only explanations i can come up with is
1. YES the DME is the one who preferred the "rental"
and
2. The insurance paid fully for it but wants month by month compliance for 10 months and if they don't get it they will take the money back they already paid and make me fully responsible for all costs?

I will be calling the insurance company tomorrow. But i wanted to ask the experts first if this sounded right? Is it possible the DME was not lying and my insurance turned in back into a sale? I am sooo confused!

neither are explanations both are assumptions. ins. dont get to take their money back once paid out
the only way for you to find out is to talk to your ins co
asking us, people who dont know your policy or even the name of your ins will not help clear things up
what we base our response on is sketchy info provided by sleep deprived people

[brucifer]

Put them in 'time-out'.
I now have two DME's in 'time-out'.
They may suspect it, but as long as I make 'nice', they can't be sure.
I just say I'm satisfying my deductible online, but the stuff online is so inexpensive,
I never reach my deductible. Odd! How do you suppose the DME's make a living?
I could care less . . .

LOL! That's how to keep them guessing! Love it!