Big screw up at DME billing office. I know, WHAT a surprise!

[SleepDepraved2]

Life only gets more interesting dealing with Lincare.

When last we left our protagonist (me), I was informed by Lincare that with my new insurance, which we got when my husband retired on July 1st, Lincare was no longer in network. Both the old and new policies are BCBS, but the new one has a more restrictive list of providers that can be used for DME. Under the old policy, Lincare was covered at 100%. Under the new, they are out of network and so covered at only 80%, leaving me to pick up the 20%. I remembered being puzzled by this, as I had found a list of SUPPORT network (the DME arm of the new BCBS insurance) providers and the Lincare that I use was on that list.

But I figured they must know, mustn't they? I decided at that point to move my business to Wright & Filippis, who are in network and who supplied me with the loaner auto BiPAP my doctor recently prescribed for me. After I had used it two weeks and returned it to be read, I had finally gotten the word from the local Lincare office that they received the RX for my permanent auto BiPAP and I had told them I had to switch to W&F in order to get it paid at 100 percent, at which point the lady at the local Lincare office offered to fax it to W&F, which was sweet of her. That is the story where we left it last time, dear readers. It sounds like the beginning of a fairly happy ending doesn't it? BUT....

DUH DUH DUH!!! (cue cheezy organ music here)

I got a bill from Lincare yesterday for about $100. As I stared at it puzzled, I noticed that they were billing me for charges incurred on June 28, the date I got my machine. BUT, on that date I was still under the OLD insurance policy, at which point I was covered 100%. I know this because Lincare sent me a letter stating that that was my coverage and asking me to call if I had any changes in insurance, which I did once we got switched over to the new policy. Why was I being charged 20% for charges incurred while I was being covered 100%?

So I called up Lincare and told the agent this. She insisted that they had billed the old insurance for that date, not the new, and that she had spoken to Pat at the insurance agency (like I knew them all by name) who told her that I had a 20% copay. She invited me to call the insurance company myself.

Yours truly went diving into my special Sleep Apnea file and grabbed all the paperwork I have received regarding this trip through the rabbit hole. Here were the Explanation of Benefits from the new insurance and the old insurance. Sure enough, there were no EOBs on these charges from the old insurance and none online when I looked either. On the other hand, there were EOBs with these charges on the new insurance. I called the SUPPORT network. The agent I spoke to there got VERY intrigued about how Lincare had charged them when they should have been charging the old insurance policy. She said they had also done something with a prior authorization which they should not have done. She said she would definitely be looking into it and would help in getting resolved. She also told me (and this was the kicker) that some Lincare offices ARE in network and some are not. It's possible that the agent at Lincare had submitted under the wrong NPI code and that I wouldn't have to pay anything. She suggested I contact the local Lincare to check as to whether they are in network (which I could have sworn they had said they were) and tell them that if I was covered 100%, I wouldn't switch to another provider and that it was possible that even if I wasn't covered 100%, they might be willing to eat the difference just to keep me as a client.

So I called the local Lincare where the very nice person there said she would check into it for me and tried calling my customer service representative at the billing office to tell her that they have screwed up my account royally and that the insurance company had a couple of bones to pick with them. Naturally, they have yet to call me back.

In the meantime, I have heard nothing back from W&F, who should have my prescription by now and have done NOTHING to get me my machine. Will SleepDepraved2 get her auto BiPAP? Will she bid farewell to Lincare, when Wright & Filippis seem so uneager to have her business? Will the agent at the Lincare billing office spend many uncomfortable minutes explaining to the insurance company how she screwed this up? Stay tuned next week for the continuation of this thrilling stooorry on next week's installment of "Auto BiPAP is a Many-Splendored Thing."

[purple]

I agree that it is silly that we have to keep a mountain of paper to keep someone from trying to cheat us out of money. and it is the future of health care.

[chunkyfrog]

It has been thus for quite some time.
They seem to be getting more skilled at it, too.

[SleepDepraved2]

well it gets even better.

I've made two payments to Lincare.

The first one was for $24.21. The second bill I got reflected this, showing my payment at the bottom of the bill.

Guess what. On the third bill, the charge of $24.21 is my beginning balance again. It doesn't show my second payment at all. They are double charging me for the $24.21.

But it's even better than that.

On my first bill, there is a charge for 7/28 for RENT-CAP HUMIDIFIER, HEATED with the customer amount due of $3.24, which was included in that $24.21.

On the latest bill, this item makes another appearance for the same date with the amount due of $1.92. Why am I being charged again for something I supposedly paid for on the first bill? And since of the amount of my first bill is no longer showing up as paid, essentially I would be paying two more times for something I supposedly paid for on the first bill.

Bastids.

[maddyn]

Years ago I watched as my old man, constantly found errors in insurance billings and had to argue with those idiots. So, Like him, I save every single bill and reciept just in case. Its a shame that someone you pay for a service tries to cheat you every chance they get, but such is life.

I Noticed you said the word RENTAL. Some insurances rent you the machine for a while instead of just buying it outright. This might be why your getting charged monthly. Check to see if they rented it for you, or if when you got it they bought it outright. If They bought it when your insurance was at 100%, you shouldnt be paying any new fees. Otherwise.........Looks like they pulled one over on you. Good luck.,

[SleepDepraved2]

I believe it is done with a rent to buy option with most BCBS, so I was aware of that. They don't want to flat out buy it for you if you might not be compliant, so this works well for them. If you end up being compliant, you end up owning the machine. If not, it's just a rental and goes back to the DME.

I did hear back from the gal at the SUPPORT network, and she says she is still working on it. She did confirm that they weren't supposed to be billed and is going to contact the local Lincare to see if they had a different NPI code to submit instead of the one the billing office used. I did find the local Lincare on the 2009 SUPPORT network list of providers for this policy and told her that I did, so she is going to try to get a better code for the present bills I am paying.

Still have not heard back from Lincare billing or from W&F.