Has anyone ever received a DME bill like this one?

[avi123]

It covers my S9 Elite CPAP which is on Medicare rental and other charges to be paid by Medicare and by my Supplementary insurance and from my own pocket.

I took out names.

[yardbird]

Did you consent to paying a portion out-of-pocket? I don't think they're allowed to balance bill on Medicare.

[avi123]

Did you consent to paying a portion out-of-pocket? I don't think they're allowed to balance bill on Medicare.

Apparently this is extra supply that I have ordered such as Resmed Gecko Nasal Pad. Yes, it happened to me in the past. The thing to do is to avoid ordering non Medicare covered items from Medicare approved DMEs. Instead, buy it on the Web. The problem is that if you ask a Medicare approved DME if an item will be covered by Medicare they will tell that they don't know until they send in the charge.

Another issue that I find let's say with masks. If you ask a Medicare approved DME about its mask exchange and return policy it will tell that it's either does not exist or give you a ridiculous answer. IMO, this because the DME is in a rush to charge and rather not waste time with delays.

[RandyJ]

It would be interesting to see all of the Medicare and Blue Cross EOB's that go with these charges.

[Tip10]

The first thing that jumps out at me is the one non-allowed amount written up as a charge and not a write down -- all non-allowances should be credits (or writedowns) to the total -- not charges inflating the total -- they are already included in the inflated prices in the total.

But yeah -- it'd be interesting to see the EOBs on all of this.

[chunkyfrog]

Those little devils really bend over backwards to make it impossible to figure out.

[diekatzepap]

What is the not allowed 56.92 charge being billed to you? Shouldn't the DME write that off if they accept Medicare assignment? Also does your Blue Cross sup plan follow Medicare guidelines? I would only pay $63.08. The bill does not show the line items being billed it just shows the payments and contractuals(not allowed). There is a HCPCS billing code for each item they bill. On the Medicare website there is a list of each of the codes and what Medicare will allow for each of them or if it is a non covered item. You should ask the DME for that code and either call Medicare or look on the website before you order the item to know if it will be covered or not. The website is quite a challenge to navigate for this info but with much persistance it can be done. By law you have a right to a line item bill with all charges listed to be provided to you. You just need to request it. Hope this helps.

[LSAT]

Avi indicated that he ordered some "non medicare covered items".

[RandyJ]

What is the not allowed 56.92 charge being billed to you? Shouldn't the DME write that off if they accept Medicare assignment? Also does your Blue Cross sup plan follow Medicare guidelines? I would only pay $63.08. The bill does not show the line items being billed it just shows the payments and contractuals(not allowed). There is a HCPCS billing code for each item they bill. On the Medicare website there is a list of each of the codes and what Medicare will allow for each of them or if it is a non covered item. You should ask the DME for that code and either call Medicare or look on the website before you order the item to know if it will be covered or not. The website is quite a challenge to navigate for this info but with much persistance it can be done. By law you have a right to a line item bill with all charges listed to be provided to you. You just need to request it. Hope this helps.

Some insurances allow certain balance amounts to be billed to customer, as in the case of ClimateLine tubing and disposable filters. In the case of ClimateLine tubing, most insurances will allow for regular tubing, and the DME will write off the difference between the allowed amount and the billed price of regular tubing. The difference between the cost of the ClimateLine and the billed price of the regular tubing can be billed to the customer. (I haven't yet heard of any DMEs who write it off).

I don't know if that is the case for this $56.92, but this would be an example of when it is allowed.

[idamtnboy]

In the case of ClimateLine tubing, most insurances will allow for regular tubing, and the DME will write off the difference between the allowed amount and the billed price of regular tubing.

Medicare allows heated tubing, code A4604.

[avi123]

Explanation of my DME bill from 11/1/2011 to 11/30/2011

1. All my check marks jibe with BCBS (my supplementary ins) Explanation Of Benefits statements.

2. Those reference numbers could be per codes or per sequence. I don't know.

3. The Non Allowed Amount of $74.25 with Date of Service 10/16/11 (at top of bill) , is b/c Medicare did not allow the full charge of $150.00 which shows at the bottom of the bill with same date of service. Medicare paid only $60.00 instead of $150.00 charged. So BCBS paid additional $15.15. The $74.25 as Non Allowed Amount is the diff of $150.00 minus $60.60 minus $15.15 = $74.25

4. The other Non Allowed Amount of $56.92 on date of service 10/21/11 is b/c Medicare approved as zero the $120.00 charge of 10/21/2011. But BCBS went ahead and paid the DME $12.62. On another charge (not seen on above bill) dated 10/21/2011 with same ref of 0100 Med Equip, of $240.00, Medicaid paid $50.46 but BCBS paid zero, with a note Denied: Duplicate service previously processed. I need more time to calculate this transaction and understand the result of $56.92 being on the Charges column.