Company A or Company B -- Please help

[HealthyandHopeful]

No, I don't plan on paying them their upgrade fee. But I will wait and see what happens after the insurance talks to them -- if they will waive it or if they insist on charging it. I would go back to Company A and pay the $431 to them before I pay that. I've been though the endless calls trying to find a DME in my area to work with, but I will do it again if I have to. How disappointing.

Pugsy, you make a good point -- they are making money even at the $861 agreed upon price. They just want to make more money off of me. I already paid a $50 copay just to see the doctor last week -- a requirement to work with them. It was a good appointment, and he explained things well. I was so happy when I left that day. This provider has a premium rating with UHC -- the doctor does anyway. Ugh.

[Nick Danger]

You can keep the doctor, but use a different DME. I really like my ENT, but I'm not going to buy equipment from him.

[Pugsy]

This DME and the doctor recently you saw are in cahoots?? Meaning you couldn't use this DME until you saw this doc and he has some sort of affiliation with DME B?
That would explain a lot. More weasels.

[HealthyandHopeful]

This DME and the doctor recently you saw are in cahoots?? Meaning you couldn't use this DME until you saw this doc and he has some sort of affiliation with DME B?
That would explain a lot. More weasels.

Yes, it's the same office. They specialize in sleep.

Meanwhile, I do still have the prescription from my PCP for an autopap (I think that's what it says) machine with settings of 7-12. But it doesn't specify the brand. I can send it by fax to a DME in network that I have the number for and see what happens with that. Wish I had done it already. There is no way to talk to them at all. I have tried. I hoped to find a local DME, in network, that I could deal with face to face.

[bwexler]

I would put in a call to DME B and ask for the branch manager. I would explain the situation and ask why they think I should pay them more than the insurance contracted price.
If I didn't like his answer, I might ask if he has phone numbers handy for BBB, state attorney general, and the local TV stations consumer rip off reporter. Then ask if he wants to stand by his decision to rip you off. I would make it clear I had no intention of paying the $292 profit building rip off charge. I would definitely emphasize the phrase "rip off" through out the conversation.
Good luck. Be strong. Bring home your new S9 Autoset tomorrow.

[HealthyandHopeful]

I would put in a call to DME B and ask for the branch manager. I would explain the situation and ask why they think I should pay them more than the insurance contracted price.
If I didn't like his answer, I might ask if he has phone numbers handy for BBB, state attorney general, and the local TV stations consumer rip off reporter. Then ask if he wants to stand by his decision to rip you off. I would make it clear I had no intention of paying the $292 profit building rip off charge. I would definitely emphasize the phrase "rip off" through out the conversation.
Good luck. Be strong. Bring home your new S9 Autoset tomorrow.

Wow! I will make some phone calls again tomorrow!! Thanks! I'm not quite this bold but I will do my best!

Funny thing -- I told this doctor about my bad experience with Company A. As I left, he gave me his card and asked if I would pass their name (Company B) on to my PCP, in light of the bad experience with the company the PCP referred me to (Company A).

[HealthyandHopeful]

I am again confused (again) and hope someone can help me understand (again).

I googled and found a DME in my area (sort of). I called and though they are out of network, she said they will charge me as if they were in network, honoring in network benefits. This time it seems too good to be true.

She said that I will pay them my deductible amount ($325) and that is all. Not the 20% in addition, making the total $432 (plus humidifier cost, surely). Just the $325. I asked several times and she insisted that the deductible amount is all I would pay for the S9 Autoset. I need to email her my prescription, insurance info (to be sure of benefits) and my name, DOB, etc.

Has anyone had this experience and is there anything I should look out for??

[Nick Danger]

I think you've learned a lot of the things to look out for the hard way! Make sure there is agreement between you and the DME regarding the specific model of machine they will supply, make sure you both understand whether the machine is to be new or used, if it is used - make sure that they disclose how many hours it has been used (you can check it when you get it), and verify the cost after they have reviewed your insurance. Make sure that there is agreement with respect to return and exchange policies. These companies are making nice profits by selling the machines and accessories.

[bwexler]

My first DME almost 4 years ago provided me with a Resmed S9 Autoset.
The invoice I received for for just under $2600 including machine Humidifier heated hose and mask.
They di accept what the insurance paid on a rent to own basis. In a year and a half they provided what ever I asked for and NEVER asked me for a dime. No copay ever.

Good DMEs do exist, they are just hard to find and are not always in network, this one I just described was out of network.

Thisrd time's the charm. Good luck.

[Cpappmomma]

Don't go with a provider that says they will be in-network rates when they are out of network. Because you have different deductibles for both in and out of network, when the dme bills and they are out if network, the insurance will apply it to your higher out of pocket deductible and you will end up being billed as it was applied to your deductible. Essentially, all the dme would get paid is the money you are paying them, they won't receive any monies from your insurance. If your deducts were the same and in-network were benefits were 80% coverage and out of network benefits were 70%, the dme is saying they would write off the 10% to make it even out for you. However, this is not your case and you will end up paying for it in the end.
I know there aren't many Lincare fans here, however I've done well with them. They are
In network with United Healthcare and will do auto sets.

[HealthyandHopeful]

I have been working with Company C since Friday -- just 6 days, and if all goes as planned I will pick up my new Resmed S9 Autoset machine at 2 pm today! This company has been polite, despite my numerous calls to check on things to make sure they had the insurance info and authorization, and to make sure they had the right prescription. During this time, I have a new doctor and had to get a new prescription (the old doctor didn't include all of the needed info on the prescription, like my diagnosis). Even with all of this, it seems to have worked out.

I have talked to them and was given a price -- the price is less than I expected to pay. Because the total cost of the machine plus humidifier (before insurance) wasn't even $1000 I didn't have to wait for authorization -- they called the insurance and were told it wasn't needed. My cost, including my $325 deductible will be $431 total for BOTH the S9 and the H5i humidifier. This may even include my 3 months worth of supplies.

I was in such shock. I asked shouldn't I owe more than that? Is this a new machine? It's new and I don't owe more. I am so relieved. I never knew something like this could be SO stressful! Including the time that I worked with Company A (who offered an "under the table deal" then sold me a "very lightly used" that had 1500+ hours, used 206 days I saw once I got it home) ... anyway ... including the time I worked with them and used that machine for 2 weeks, returned it, looked for another company, went to Company B and paid my $50 copay to see the doctor then they wanted to charge me that $292 upgrade fee over their agreed upon price since they are in network (they never did return a call to my insurance about this)... and then found Company C and got everything approved it has been about 6 weeks. I don't know if this paragraph makes sense, but it's just taken a long time to get to this point.

I am thankful to have found Company C. They aren't that far from me and I can work with them long term. She said that I can pay half today and half in a month. I think this is for my convenience. I did ask her why is that (I've been warned about balanced billing) but I think it's just a courtesy.

I will let you all know when I get home (hopefully) with my machine!!

Thankful for answered prayers. Thankful for all of you in this forum!

[Janknitz]

Crossing fingers that Company C is true to their word. Be sure you check the model name AND run hours before signing any document accepting the machine.

Good luck,

[HealthyandHopeful]

Wow, I came home with the machine I wanted, and a new mask. A very helpful technician helped me with the mask fitting, let me try it with the machine on, showed me how to use the machine and charged me the amount he should have charged me. Tomorrow he is sending in the mail to me extra nasal pillows, hoses and filters. I am to go back in a month for him to check my usage. Then three months from now I will be contacted about sending additional supplies and this will happen every three months. I can change my mask at that time if I want to. The cost was even less than I expected. I kept waiting for the other shoe to drop. I read my paperwork before signing, I looked at the settings to make sure there were no hours on the machine, I looked at the name of the machine -- every seems to be on the up and up. I met the lady I have been working with by phone since Friday and gave her a hug.

I cannot thank everyone on this forum enough for pointing me in the right direction. I got my prescription written in the way it should be for me to get the autoset, y'all helped me to even know what an autoset is and that I should return the brick I had in the beginning, you helped me to know how my insurance works and what I should be charged and that I should run from the doctor who wanted to charge me the extra $300.

I still wish there was something I could do to save others from these companies who just want to make money off of you. I have told my insurance company. I may fill out some kind of review online. I will definitely give this company good reviews and plan to let the owner know of the profession service I was given. Other than that, I think I am going to have to just forget it and go on with my life, ready to start getting better sleep and feeling better during the day. I know I am going to have to get use to a machine all over again -- but can't wait to start that process!!

I know I'll still be here, but now with questions concerning the USE of my machine and treatment, not just in the obtaining of the machine!

[Janknitz]

I still wish there was something I could do to save others from these companies who just want to make money off of you. I have told my insurance company

THIS is why so many of us post here--it feels good to know we helped you get what you needed without being ripped off for extra money.

I think it's perfectly OK to name Company C and to let others in your area know a good DME. They deserve the good words.

[HealthyandHopeful]

Company C - Monitor Medical in Stafford, TX. Happy to have found them!

I understand what you mean. I can also now use what I have learned and maybe help someone here!