"Interesting" Visit To DME Last Friday

[TXKajun]

As most of ya'll know, I've been on XPAP going on 4 years now and am not a noob when it comes to dealing with my DME. I've been using a local DME for my mask/filter purchases and been pretty happy. My insurance covers 90% of cost after I meet my out-of-pocket deductible since my DME is in-network.

On Thursday, I received a bill in the mail from the DME for an outrageous amount from my last mask purchase late last May. I got online and checked my benefits statements and nope, nothing filed with that date. I called the insurance company and asked them about it and they also could find nothing filed. I figured I'd just have to go to the DME and let them know that they needed to file and that it was time for a new mask, but my insurance rep said whoa!!! Hang on...it seems there is a "timely filing" clause with my insurance company (Blue Cross/Blue Shield of Tennessee) and that anything NOT filed with the insurance company from an in-network provider within 180 days of the service was...get this....."NOT PAYABLE" by either the insurance company or me!! So, armed with this info, I took the bill and headed over to the DME. I talked with them about the bill, especially the part where they billed me for a chin strap.....I do NOT use a chin strap with my Ultra Mirage Full Face mask!....and let them know about the timely filing clause. They were not exactly happy, needless to say. They went back and forth a little bit, then said they'd have to look into it a bunch more. Then I said "Oh, by the way, I need a new mask, also." Of course, the rt wasn't there, they were short handed at the time since it was lunch time (1:30 PM is lunch with them???), yadayadayada. I was polite, letting them know that I'd be more than happy to head across the street to one of the other local DMEs and get my future supplies from them. Miraculously, they managed to find the exact mask I wanted (yep, the UMFF. But when did they start coming in bags and not the box?? ). I also asked for some replacement filters and managed, after some searching on their part, to get a package of 2. I asked if, as usual, they wanted my 10% copay, but they said nope, they'd bill me for it. Sheesh! Didn't they just get through with one billing screw-up??? LOLOL Oh yes, I paid my 10% copay all the other times when I picked up my masks, so don't know what happened this time.

I guess I'll be getting another bill from them....hopefully before July of next year!

Anywho, just a little saga bout my local DME.

Kajun

[NeurosurgeryNP]

Very interesting! Got to love the DME's. I am very lucky and fortunate - I have an awesome DME who goes out of their way for me.

[TXKajun]

As I said above, I've been pretty happy with my DME till this latest bump in da road. I got a call this morning from them. I also asked for a new forehead support for my UMFF while I was there (I figured, what the hey, may as well push a little.), but since the rt wasn't there, they weren't able to find one. Today, I was informed they were going to order one for me. Now if that don't make me feel special, nothing will. Course, they don't know how much it'll cost either me, my insurance company or them. But what the hey, I have 2 old UMFFs that have broken forehead supports already. Online, best price I could find was $27.99 + shipping and handling. If I can get it for the 10% copay, I'll be a happy sleeper (as opposed to a happy camper. )

Kajun