Still haven't received the ASV machine that was prescribed

[johnthomasmacdonald]

Every Day I'm calling the insurance company, my doctor's office and the DME to find out what new problem has come up - there is a new and different problem each day - this has been going on for month.

The initial problem was "my fault" because i refused an ASV machine from the DME chosen by the sleep center ( they know far less about the machines than i do which i find totally scary and bizarre but no one else seems too surprised by that and seems to find that to be reasonable professionalism) that was discontinued years ago and lacked an SD-card and I could buy on craigslist for $100. When I complained about my insurance company previously i was told by people here that the problem was that my plan was too cheap - now i have the Best ( meaning most expensive) plan offered by Horizon BCBS. I don't see any difference in their service,their business model still seems to consists of grabbing the monthly payment and then doing everything possible to avoid paying for any healthcare. I've pretty much thrown in the towel and have bought a respironics ds950hs on my own

[49er]

Sadly John, I am not surprised and don't expect things to improve anytime soon. Sorry for my negativity but that is the way I feel.

I will pass on commenting on the situation with your insurance for obvious reasons. But we are in agreement as you well know.

Glad you were in a position to purchase a machine because god only knows when you would have received one from the insurance company. By the way, I wonder if these types of delays are common for people with other medical conditions like cancer, diabetes, etc. Just wondering.

49er

Every Day I'm calling the insurance company, my doctor's office and the DME to find out what new problem has come up - there is a new and different problem each day - this has been going on for month.

The initial problem was "my fault" because i refused an ASV machine from the DME chosen by the sleep center ( they know far less about the machines than i do which i find totally scary and bizarre but no one else seems too surprised by that and seems to find that to be reasonable professionalism) that was discontinued years ago and lacked an SD-card and I could buy on craigslist for $100. When I complained about my insurance company previously i was told by people here that the problem was that my plan was too cheap - now i have the Best ( meaning most expensive) plan offered by Horizon BCBS. I don't see any difference in their service,their business model still seems to consists of grabbing the monthly payment and then doing everything possible to avoid paying for any healthcare. I've pretty much thrown in the towel and have bought a respironics ds950hs on my own

[JohnBFisher]

... I wonder if these types of delays are common for people with other medical conditions like cancer, diabetes, etc. Just wondering. ...

Yup. Both common and other issues.

For example, I do not qualify for Medicare reimbursement for insulin pump supplies. Why? Because my body creates insulin. No where near enough for my needs. But it creates some. So Medicare says I do not medically need it. They are happy to have my A1c number be way too high (a common result for me if I do not have an insulin pump).

BCBS will pay for for my insulin pump supplies (as a second and not secondary policy). But they require I go through a sole source provider (but never told me about the sole source provider). Now the sole source provider will not file the medicare forms for me, of which the Medicare denial of coverage is required before BCBS will pay. So, I'm stuck having to pay for my insulin pump supplies out of pocket.

Life is not fair and they will shaft you.

So, yes. It's not just xPAP therapy.

[NateS]

… their business model still seems to consists of grabbing the monthly payment and then doing everything possible to avoid paying for any healthcare.

You have just defined the business of the private health insurance industry. There is no public good served by its existence. It's just a money skimming operation, somewhat similar to the casino business, except that in the case of casinos, many people seem to enjoy the process. I don't know of anyone deriving entertainment value from carrying private health insurance, however.

But the health insurance industry and their bought-and-paid-for Senators and Congressmen do a great job of convincing the public to oppose national health care as "socialism." So we are first in the world in the cost of health care and 37th in the world in quality of health care.

Maybe we shouldn't have police departments and fire departments either. Let's call them "socialism" and abolish them so that private business can get in on making a profit from these activities. It will reduce our tax bill and we can just shop around for companies offering to put out our fires and enforce our laws, and let them decide who is "covered" for which fires and which crimes. Read the fine print.

Regards, Nate

[49er]

... I wonder if these types of delays are common for people with other medical conditions like cancer, diabetes, etc. Just wondering. ...

Yup. Both common and other issues.

For example, I do not qualify for Medicare reimbursement for insulin pump supplies. Why? Because my body creates insulin. No where near enough for my needs. But it creates some. So Medicare says I do not medically need it. They are happy to have my A1c number be way too high (a common result for me if I do not have an insulin pump).

BCBS will pay for for my insulin pump supplies (as a second and not secondary policy). But they require I go through a sole source provider (but never told me about the sole source provider). Now the sole source provider will not file the medicare forms for me, of which the Medicare denial of coverage is required before BCBS will pay. So, I'm stuck having to pay for my insulin pump supplies out of pocket.

Life is not fair and they will shaft you.

So, yes. It's not just xPAP therapy.

I am so sorry to hear that John. So Medicare would rather risk you being hospitalized from having a too high A1c number instead of paying for your insulin pump supplies. Yeah, that makes alot of sense

[chunkyfrog]

Warning: Don't spend your IRA; you may need to use it to stay alive.
Don't forget; medical tourism is a growing trend.
Those bast__ds are determined to scam us until we are dead.
Keep fighting.

[Sir NoddinOff]

At the other end of the spectrum, if you have GREAT insurance plus Medicare some medical providers want to endlessly string you along, soaking up every bit of money they can with a blizzard of minutiae tests and followups. Yeah, the dollars don't come directly out of MY pocket but it does get paid for by all the new members involved with my longtime insurance company. Regarding MediCare, all the taxpayers end up getting ripped off in the long run. The real down side for me personally is that all my doctors exhaust all possible resources/testing, making me wait several months for any decision... especially my sleep doctors. Don't even get me started on sleep study overkill They all know that between Medicare and my premium insurance that they can get away with ENDLESS tests without being rebuked. A sad state of affairs that betrays everybody but the medical establishment. Final note: I hope this whole rant doesn't come off sounding like another old entitled person griping about their problems. I do have a lot of sympathy for those without insurance or low grade insurance - I think it's a national disgrace. I haven't mentioned any of my medical or insurance providers by name because I'm obviously glad to be complaining about too much insurance rather than too little. And no, I don't want to trade places

[archangle]

Be sure to complain to your Congress representatives. It may not do any good, but NOTHING will happen if enough people don't complain.

[johnthomasmacdonald]

It's 1:29 PM and i've been at it continuously since 9 am this morning going back and forth between Horizon BC/BS my sleep doctor's office, the DME i dropped for trying to stick me with a brick that was discontinued years ago and the new DMA that at least claims that it has the machine i want. The doctor's office has been wonderful. Horizon never gives the same story straight. 2 days i called them to try to sort it out and after numerous switches and having to tell them my birthdate about 10 times, they ended up telling me that the doctor's office needed to cancel the original order and restart the WHOLE process including approval. They gave me the number for my doctor to call. Doctor's office called me yesterday and said they spent a total of THREE hours back and forth with them to eventually claim that I had never cancelled the order ant that I had to do that. SO i've been trying to do that all morning. It would be a total joke except that you realize that it isn't just incompetence, they hope you will eventually give up and either do without or buy one on your own.

[StuUnderPressure]

At the other end of the spectrum, if you have GREAT insurance plus Medicare some medical providers want to endlessly string you along, soaking up every bit of money they can with a blizzard of minutiae tests and followups.

You can sign up for a "My Medicare" account.
With that account, you can submit a "review" of the claim submitted by each medical professional. In that review, you can opine about the lack of necessity of any tests, etc done. This is NOT correct. Please see my 8-5-13 edit below in blue.

You can also report those excessive tests, etc. to Medicare as part of their fraud reporting initiative.

NOT doing anything about it just means it will continue to occur.

EDITED 8-5-13:

The ''review" option noted above in the red section applies ONLY to my BC/BS insurance which used to be my one & only insurance but is now secondary to Medicare.

SORRY for confusing everyone!

[NateS]

At the other end of the spectrum, if you have GREAT insurance plus Medicare some medical providers want to endlessly string you along, soaking up every bit of money they can with a blizzard of minutiae tests and followups.

You can sign up for a "My Medicare" account.
With that account, you can submit a "review" of the claim submitted by each medical professional. In that review, you can opine about the lack of necessity of any tests, etc done.

You can also report those excessive tests, etc. to Medicare as part of their fraud reporting initiative.

NOT doing anything about it just means it will continue to occur.

I use MyMedicare to check up on provider claims by reading what is listed, but I have never done a "review" - could you please elaborate on that process?

Thanks, Nate

[Sir NoddinOff]

You can sign up for a "My Medicare" account.
With that account, you can submit a "review" of the claim submitted by each medical professional. In that review, you can opine about the lack of necessity of any tests, etc done. You can also report those excessive tests, etc. to Medicare as part of their fraud reporting initiative.o occur.

Thanks, StuUnderPressure. Interesting info: I'm not sure how good my word would be against my doctor(s) or If I want to upset/challenge my medical team like that, however I'm glad to hear there is a complaint process. I'll covertly check it out. I'll admit I haven't really explored the options in 'My Medicare" but I agree with NateS, maybe a bit more detail and a non-gov't how-to link or URL might help one understand the process. Youtube video etc.

[Sir NoddinOff]

It's 1:29 PM and i've been at it continuously since 9 am this morning going back and forth between Horizon BC/BS my sleep doctor's office, the DME i dropped for trying to stick me with a brick that was discontinued years ago and the new DMA that at least claims that it has the machine i want. The doctor's office has been wonderful. Horizon never gives the same story straight. 2 days i called them to try to sort it out and after numerous switches and having to tell them my birthdate about 10 times, they ended up telling me that the doctor's office needed to cancel the original order and restart the WHOLE process including approval. They gave me the number for my doctor to call. Doctor's office called me yesterday and said they spent a total of THREE hours back and forth with them to eventually claim that I had never cancelled the order ant that I had to do that. SO i've been trying to do that all morning. It would be a total joke except that you realize that it isn't just incompetence, they hope you will eventually give up and either do without or buy one on your own.

Sorry to hear of your ongoing problems. Man, your story is a nightmare. Good on you for sticking it out... obviously they are trying to wear you down and make you 'go away'. I hope it all works out guickly and in your favor.

[johnthomasmacdonald]

It's 1:29 PM and i've been at it continuously since 9 am this morning going back and forth between Horizon BC/BS my sleep doctor's office, the DME i dropped for trying to stick me with a brick that was discontinued years ago and the new DMA that at least claims that it has the machine i want. The doctor's office has been wonderful. Horizon never gives the same story straight. 2 days i called them to try to sort it out and after numerous switches and having to tell them my birthdate about 10 times, they ended up telling me that the doctor's office needed to cancel the original order and restart the WHOLE process including approval. They gave me the number for my doctor to call. Doctor's office called me yesterday and said they spent a total of THREE hours back and forth with them to eventually claim that I had never cancelled the order ant that I had to do that. SO i've been trying to do that all morning. It would be a total joke except that you realize that it isn't just incompetence, they hope you will eventually give up and either do without or buy one on your own.

Sorry to hear of your ongoing problems. Man, your story is a nightmare. Good on you for sticking it out... obviously they are trying to wear you down and make you 'go away'. I hope it all works out guickly and in your favor.

The part that always gets me is how many americans will still try to defend this system as " the best in the world" which is just beyond belief. It isn't the best by ANY measurable standard that i can imagine. It's like someone trying to argue that NY Jets Quarterback Mark Sanchez is the greatest quarterback in the history of the sport. It's hard to even know where to begin or if the claim is really serious or is a joke.

[-SWS]

The part that always gets me is how many americans will still try to defend this system as " the best in the world" which is just beyond belief.

Well, I don't find indoctrination, dogma, delusion, or dishonesty beyond belief. Any of those might lend the statement that we Americans have the best healthcare in the world.