Cigna/CareCentrix billing sticker shock ?

[Sfrank0315]

Hello,

This is my first post. I've had my CPAP machine for about a month. I like it but I received a bill today totaling about $130 from CareCentrix for my equipment. My insurance is Cigna and it looks like they paid 80%. However, I vaguely remember being told that the machine starts out as a rental, so my question is am I going to be billed this money from CareCentrix every month as a rental fee? If so, that seems pretty high and I'm annoyed that no one told me to expect this even after I asked if something like this would happen (I hate sticker shock). I just got finished paying Cigna nearly $300 for my medical appointment and sleep study. My other question - has anyone received separate bills from CareCentrix for each piece of equipment. I received six invoices in one envelope. I really don't want to have to write six checks or fill out my debit card information six times. Why don't they just lump it together in one invoice? This is a waste of paper. Anyway, I am OK paying $130 if this is a one-time fee but I am not OK with paying this every month. Of course, this came on a Saturday so I can't call until Monday.

Any feedback would be appreciated. Thanks!
Steve

[BlackSpinner]

Some of the equipment you buy up front - hose, humidifier, mask. They are not returnable. The machine is.

[Wulfman...]

Hello,

This is my first post. I've had my CPAP machine for about a month. I like it but I received a bill today totaling about $130 from CareCentrix for my equipment. My insurance is Cigna and it looks like they paid 80%. However, I vaguely remember being told that the machine starts out as a rental, so my question is am I going to be billed this money from CareCentrix every month as a rental fee? If so, that seems pretty high and I'm annoyed that no one told me to expect this even after I asked if something like this would happen (I hate sticker shock). I just got finished paying Cigna nearly $300 for my medical appointment and sleep study. My other question - has anyone received separate bills from CareCentrix for each piece of equipment. I received six invoices in one envelope. I really don't want to have to write six checks or fill out my debit card information six times. Why don't they just lump it together in one invoice? This is a waste of paper. Anyway, I am OK paying $130 if this is a one-time fee but I am not OK with paying this every month. Of course, this came on a Saturday so I can't call until Monday.

Any feedback would be appreciated. Thanks!
Steve

Welcome to the world of doing business with DMEs and insurance providers.

Most find it's more cost effective (and less aggravating) to just purchase the equipment outright. At worst, the costs may come out even. But, more often, purchasing outright from an online supplier (like CPAP.COM) is less expensive.
Yes, the DMEs are allowed to charge for each little piece of equipment.
Although there are some differences with each insurance provider and their contractual agreements with the equipment providers, there are also some similarities. These forum pages are full of the "horror stories".
Be sure to read your contracts VERY CAREFULLY AND COMPLETELY.


Den

.

[Wulfman...]

And, be sure to find out that the equipment they're dispensing to you is FULLY DATA-CAPABLE.
Insurance pays by "codes". The code for a high-end machine is exactly the same as the lowest end machine. If they (try to) give you a low-end machine, you'll know that they're putting their profits above your therapy. Don't accept a non-data-capable machine. Know your equipment before they try to give it to you.

Edit: After rereading your original post, I see that you've already had your machine for about a month.
WHAT DID THEY GIVE YOU?


Den

.

[jtravel]

I would have expected that they would have gone over the total costs and how much you would be required to pay before agreeing to their treatment plan?
Is it mandated that you must purchase the equipment from Carecentrix or do you have other options?
I know they are the ones that approve or disapprove sleep studies ordered by DR's as I have just experienced that myself. did they approve a lab sleep study for you or in-home?

[msla]

If the $130 is the monthly co-pay for the rental until bought, then you could pay $589 to the host of this forum, or 4 1/2 months rental for a ResMed S9 Auto set for her, and have no further rental payments. Of course you will have an excellent machine if you go this route. I'm cheap so the pink machine does not bother me in the least.

[jtravel]

If the $130 is the monthly co-pay for the rental until bought, then you could pay $589 to the host of this forum, or 4 1/2 months rental for a ResMed S9 Auto set for her, and have no further rental payments. Of course you will have an excellent machine if you go this route. I'm cheap so the pink machine does not bother me in the least.

Is the color the only difference between the two?

[Pugsy]

You need to check with your insurance company directly and find out what the rental thing is and how it lasts before you have paid for it and there's no longer any rental involved. It all depends on the insurance...for some it's 3 months and for some its 12 or 13 months.
It's called a "capped rental" when once so many rental months have been paid the machine is considered full paid for.

Also look closely at the bill. Typically the humidifier is considered a one time purchase and with capped rentals only the blower is "rented". When this happens the first bill will include that one time humidifier cost and subsequent "rentals" only pertain to the blower unit.
This is what is usual...now your insurance policy might be doing something totally different and that's why you should call your insurance company yourself and find out what their policy is for machine rent to own and the time frame involved.

[sfrank0315]

And, be sure to find out that the equipment they're dispensing to you is FULLY DATA-CAPABLE.
Insurance pays by "codes". The code for a high-end machine is exactly the same as the lowest end machine. If they (try to) give you a low-end machine, you'll know that they're putting their profits above your therapy. Don't accept a non-data-capable machine. Know your equipment before they try to give it to you.

Edit: After rereading your original post, I see that you've already had your machine for about a month.
WHAT DID THEY GIVE YOU?


Den

.

I received a ResMed Air Sense 10. Yes, it's a data-capable - I have a card that records everything but the nightly sleep information is also uploaded to my doctor each day, Cigna, and the equipment supplier through cellular data. I've already received a phone call from Cigna saying that I have been compliant with my usage.

[sfrank0315]

You need to check with your insurance company directly and find out what the rental thing is and how it lasts before you have paid for it and there's no longer any rental involved. It all depends on the insurance...for some it's 3 months and for some its 12 or 13 months.
It's called a "capped rental" when once so many rental months have been paid the machine is considered full paid for.

Also look closely at the bill. Typically the humidifier is considered a one time purchase and with capped rentals only the blower is "rented". When this happens the first bill will include that one time humidifier cost and subsequent "rentals" only pertain to the blower unit.
This is what is usual...now your insurance policy might be doing something totally different and that's why you should call your insurance company yourself and find out what their policy is for machine rent to own and the time frame involved.

I looked at my paperwork and even though it doesn't explicitly state it, it looks like the rental period is 90 days, so yeah, 3 months. It states that I need to return my SD card after 90 days.

I signed up through CareCentrix's portal for online pay. I just hope I don't have to pay this each month. If the only recurring portion is the unit itself, then that only comes to about $25. I got charged more for the tubing then the unit itself. I just wish this would have come on a day during the week so I didn't have to wait a few days to call. Thanks for the feedback.

[sfrank0315]

I would have expected that they would have gone over the total costs and how much you would be required to pay before agreeing to their treatment plan?
Is it mandated that you must purchase the equipment from Carecentrix or do you have other options?
I know they are the ones that approve or disapprove sleep studies ordered by DR's as I have just experienced that myself. did they approve a lab sleep study for you or in-home?

It was very rigid. My insurance, Cigna, first requires a consultation with a sleep specialist and then an at-home sleep study so that's what I did. Once I got diagnosed with sleep apnea, I went to the only supplier in my area that Cigna authorizes. They are called Keene Medical. I went there and then got the bill from them via CareCentrix so I didn't have options. Cigna paid 80% so I'm not upset that I was denied anything. I just hope that this does not recur every month because over time that would be a rip off (My wife and I pay a lot for this insurance).

[Okie bipap]

Which model of the AirSense 10 did you get? Not all of them are fully data capable. The AirSense 10 CPAP is not full data capable. It will give basic data only. The Elite, Auto, and Auto for Her all are full data capable machines. All four models have SD cards, but only the last three models have full data capability.

[mike1953]

You need to check with your insurance company directly and find out what the rental thing is and how it lasts before you have paid for it and there's no longer any rental involved. It all depends on the insurance...for some it's 3 months and for some its 12 or 13 months.
It's called a "capped rental" when once so many rental months have been paid the machine is considered full paid for.

Also look closely at the bill. Typically the humidifier is considered a one time purchase and with capped rentals only the blower is "rented". When this happens the first bill will include that one time humidifier cost and subsequent "rentals" only pertain to the blower unit.
This is what is usual...now your insurance policy might be doing something totally different and that's why you should call your insurance company yourself and find out what their policy is for machine rent to own and the time frame involved.

I looked at my paperwork and even though it doesn't explicitly state it, it looks like the rental period is 90 days, so yeah, 3 months. It states that I need to return my SD card after 90 days.

I signed up through CareCentrix's portal for online pay. I just hope I don't have to pay this each month. If the only recurring portion is the unit itself, then that only comes to about $25. I got charged more for the tubing then the unit itself. I just wish this would have come on a day during the week so I didn't have to wait a few days to call. Thanks for the feedback.

My guess is the 90 days is the compliance period for the insurance. Just about all insurance have a 90 day compliance period to make sure you are using and getting good treatment before they will continue payments. Call you insurance to find out exactly what the rental period is.

[jtravel]

I looked at my paperwork and even though it doesn't explicitly state it, it looks like the rental period is 90 days, so yeah, 3 months. It states that I need to return my SD card after 90 days.

I signed up through CareCentrix's portal for online pay. I just hope I don't have to pay this each month. If the only recurring portion is the unit itself, then that only comes to about $25. I got charged more for the tubing then the unit itself. I just wish this would have come on a day during the week so I didn't have to wait a few days to call. Thanks for the feedback.

If you received six different invoices then it must breakdown what each is for right?
The $25 rental fee is most likely for the 90 day period. It sounded like a titration study was not performed and they are using the 90 day Apap rental period too analyze the data from the machine and then decided what you need.
You said you paid close to $300 for the sleep study and DR visit, is that 20% of the total cost with Cigna paying 80% ?

[Wulfman...]

And, be sure to find out that the equipment they're dispensing to you is FULLY DATA-CAPABLE.
Insurance pays by "codes". The code for a high-end machine is exactly the same as the lowest end machine. If they (try to) give you a low-end machine, you'll know that they're putting their profits above your therapy. Don't accept a non-data-capable machine. Know your equipment before they try to give it to you.

Edit: After rereading your original post, I see that you've already had your machine for about a month.
WHAT DID THEY GIVE YOU?


Den

.

I received a ResMed Air Sense 10. Yes, it's a data-capable - I have a card that records everything but the nightly sleep information is also uploaded to my doctor each day, Cigna, and the equipment supplier through cellular data. I've already received a phone call from Cigna saying that I have been compliant with my usage.

WHICH SPECIFIC MODEL? If it's NOT an Elite or Autoset model, it's NOT DATA-CAPABLE.

Just because it's got a "card" in it, doesn't mean it collects anything other than hours used.
"Compliance" is NOT an indication of effective therapy........only that you're using it the required number of hours.

Find out what you have.


Den

.