Billing questions

[Scarlet834]

I find it very interesting that I have not received, to date, any costs, charges, co-pay requests, bills, anything related to my sleep titration studies (the sleep lab) or my subsequent CPAP equipment (the DME). The sleep study might actually not have a co-pay, based on other diagnostic tests I've had in the past. My DME was very forthcoming when I asked about what the various pieces of equipment cost, so I have funds tucked aside safely away from Xmas present money. But nothing formal yet. It appears I will eventually be billed directly after receiving payments from my HMO insurance company. I found it especially queer not to be asked for any co-pay dollars up front and that nobody wants any money from me yet going on two months.

Just curious about other people's experiences?

[Wulfman]

Have you talked to your insurance provider? These situations vary a great deal. Some insurance providers require a copy of the sleep study (to be scrutinized by their own medical staff) before they approve the expenditures for the equipment.
The co-pay may not apply until all the bills are accumulated and your deductible is met.

Den

[potholerepairman]

The best way I found to find out what you will owe for dme charges is to look on the insurance web site under claims to see what they have submitted on you.You don't want a bill before your insurance company cuts the bill down to allowable amount, then you will owe what ever percentage(20% for me) if you have already met any deductable.For UHC that comes out to about 7 bucks for 2 nasal pillows (lt), 2 machine filters, and a chinstrap.Its true you want to know what you owe in case of some crazy charges so go online if you can on your insurance companies website.With my UhC policy the sleep lab was 100% free.My dme sends a bill real quick that is nice so maybe just call and ask if they sent it out yet.By reading on here it seems dme's like to send out bills to keep you out of the office and way which if you have no problems works for all.

[GumbyCT]

I have read of times when the DME messes up the insurance billing over and over and then some months later the patient is billed for the entire amount. BEWARE!!!

[Scarlet834]

Thanks for the advice, all.
I do have pre-approval from my insurance company for all services received, just no $$$s to date. I pulled out my coverage book and don't seem to owe a copay for diagnostic testing. I also know that what the DME bills is not necessarily what what will be allowable by insurance, and my portion is only based on that allowable.

This is very odd to me, as I have never had medical treatment before where someone didn't want a down payment based on estimated coverage. I'll see what I can find out on line, and may take the advice to talk to the insurance provider directly.

Edit - Hey, potholerepairman, thanks for the advice to go to the insurance site. I've never, ever, looked up claims there before, but there they are!

[leejgbt]

You mentioned that your insurance is an HMO and that your treatment and equipment are pre-approved. This usually means that the DME provider has agreed to bill the co-pay amount only after your insurance has paid. So, this is why there was no up front money. However, two months is too long so get a status from your insurance as to whether the claims have been billed and if so have they been paid. If they have been paid ask your DME what is taking so long. You might be alerting them to an intake error they were unaware of like wrong birthdate or insurance ID number. Good luck.

[Scarlet834]

Thanks! As it turned out, the billing statement finally showed up yesterday. Just more time lag than I ever expected. So now I know my monthly rental obligation--I just don't know the full purchase price (except that I did ask the DME that question so I have a pretty good idea). On my insurance website it looks like a check was only just cut to the DME on 11/3.

This is such a very different experience from having my teeth capped and having the whole financial obligation laid out in advance!