DME billing question

[Patches]

I started my therapy December. I went through Lincare. My question is... How long does it take for DME's to bill insurance companies? I have not received any bill and i followed up today. DME said they havent billed yet... I asked if my contract was rent or purchase they said 10 months rent. But have no exact amount of how much i will be paying. Is this normal?

[Redrite]

It really depends on the DME company. Lincare is a national chain and they do there billing through corporate offices, smaller DME's need the cash flow so they are more apt to bill right away. If you have say Medicare, the humidifier mask and disposables are billied as a purchase. The cpap machine is rented for 13 months then owership is transferred to you
.
Some insurance companies will ask for your compliance info ( thru a smart card or modem) after three months then will accept a straight purchase. This would be less then renting it in alot of cases. Im guessing Lincare is in Network. I would call them and ask what EXACTLY what your cost would be. They know, since they get an authorization before delivering the machine and you have every right to know how much is owed. Hope this helps.

[Janknitz]

I'm surprised because Crapria insists you pay whatever they THINK your share is going to be up front before they will deliver the machine or supplies. They are all about the money.

[jules]

with LIncare - be prepared for a collection threat letter before you ever get the bill.

[Kahfree]

I was wondering the same thing. I have Advanced Homecare and they said they would bill me. I was told I needed to put $300.00 down, which I did, and the rest will be paid in 9 monthly installments, but so far, I have no bill. I do go back to the doctor on Monday and at Scripps in CA, the DME works in the doctors office. I hope to have an answer then for myself. The rep told me that after 9 months I own it. I am going to ask him though, does that mean since I am renting and If I want a different machine, I can switch? Just curious. I like my machine, but I am just curious.

[Patches]

Thank you for the reply. Im just a bit frustrated and anxious as i do not know how much I would be paying. Its always a question of either renting or buying? As with my case i still cant decide because DME is still doing the paperwork. I would call them again on monday.

[LinkC]

I have a local brick-and-mortar DME. My machine was rent-to-own for 10 mos. My copay was about $25/mo. Don't remember (or care) what Ins paid.

I got a new mask back in Aug '10...just got the bill for my co-pay last week. Oopsie! Usually they are MUCH quicker than that.

Don't worry. They WILL bill you. That much is certain!

[avi123]

I started my therapy December. I went through Lincare. My question is... How long does it take for DME's to bill insurance companies? I have not received any bill and i followed up today. DME said they havent billed yet... I asked if my contract was rent or purchase they said 10 months rent. But have no exact amount of how much i will be paying. Is this normal?

Reply:

You wrote above: "I went through Lincare". As I understand it, you went tru Lincare just for getting your CPAP supply and for nothing else.

I am a retiree, insured by Medicare and also have a medigap policy by BCBS. So in my case it is not a question if it pays to rent or buy b/c I use my insurances to cover lots and lots of ailments. By the way, the average benefits of a U. S. retiree who is covered by Medicare (parts A and B), alone, has been half a million dollars over his/her life time.

The following are my allowances for CPAP supply replacements. I could get more, "free", if I show a specific Rx from my Doc (any Doc). Otherwise, I need to pay cash and/or buy it PRIVATELY.


A7030, full face mask: 1 per 3 months
A7035, headgear: 1 per 6 months
A7038, disposable filter: 2 per month
A7037, tubing: 1 per 3 months
A4064, heated tubing: 1 per 3 months
A7031, full face mask cushion: 1 per month
A7036, chin strap: 1 per 6 months
A7046, disposable humidifier chamber (does not open): 1 per 6 months

E0601 & E0562 CPAP & humidifier: Medicare has very strict guidelines on replacement CPAP’s and humidifiers. They will provide a replacement every 5 years from the date of purchase, not the date you received equipment. They rent for total of 13 months.
They also require additional documentation from your MD in order to replace this equipment.
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To follow my DME's (who is a Medicare approved provider) accounting with my insurers is very difficult. Often, my DME keeps charging in duplication over and over and is denied. I keep getting requests from my insurers to go over the bills and report FRAUDS. But it's impossible to pin point.