O/T laugh at DME

[Kitatonic]

Yesterday my insurance provider called to ask me if I need a wheelchair as requested authorization by Apria who attached my 2011"critically severe" sleep study as justification.

[bwexler]

Of course you need a wheel chair. How else are you going to move that big heavy PAP machine around.

[chunkyfrog]

Just a clerical error, I'm sure. They never attempt fraud.
Getting caught is so . . . gauche!

[nanwilson]

Yes.. you do need a wheel chair, ........ how else are they going to make more money off of you . I'll bet they have pulled that one on many patients and have been paid by the insurance company... and... no one receives a wheel chair. If the insurance company doesn't query the item with the patient... no one would be any wiser . The DME would make more $$$$$$ and the insurer would be out of pocket and the patient would never know. What else are they going to use to SCAM the system .

[jnk...]

I never laugh at the DME. I consider it impolite to laugh at people with obvious mental limitations.

[Wulfman...]

Yesterday my insurance provider called to ask me if I need a wheelchair as requested authorization by Apria who attached my 2011"critically severe" sleep study as justification.

Identity theft? ( or another form of insurance fraud? )


Den

.

[Krelvin]

Just had the billing for the DME show up on the UHC website today.... Interesting. Not sure who is laughing...

Code: Select all

Service Dt   Item                           Billed  Disc    Paid
09/18/2014   Cpap Headgear                  $ 28.00 $ 12.79 $ 15.21 
09/18/2014   Full Face Mask (cpap)          $175.00 $102.85 $ 72.15 
09/18/2014   Replacement Face Mask          $ 75.00 $ 48.31 $ 26.69 
09/18/2014   Cpap Device Filter             $ 20.16 $ 16.04 $  4.12 
09/18/2014   Breathing Machine Tubing       $ 40.00 $  8.77 $ 31.23 
09/18/2014   Breathing Assistance Device    $250.00 $130.04 $119.96

What I got:
o Machine (S9 bi-level Auto) - Pretty sure this is a rental right now
o 1 Filter (should come with the machine according to Resmed)
o Heated Tubing which would be part of the Humidifier but might be an extra cost.
o Attached Humidifier (was billed separately)
o 1 mask which came packaged with the headgear (ie it is a bundle)

What I didn't get:
o Standard tubing which comes with the machine
o A "Replacement Face mask" whatever that is.

Looks like they billed for two masks, a headgear which comes with the one of the mask (no idea about the second one since I didn't get a second mask), the Heated Tubing, and a filter for the machine.

Also there is no mention of co-pay, even though I had to pay one but was told by the Insurance company I had already reached my maximum for the year in co-pays and out of pocket expenses and should not have had to pay a co-pay.

[Demerit]

The filter is billed separately. The headgear is billed separately. Pretty sure that's the price for a heated tubing. Unless you received a separate "cushion" which is the mask replacement, then you should not have been charged for it.

[Janknitz]

Sure hope they investigate that DME for fraud, Kit.

[ems]

Yesterday my insurance provider called to ask me if I need a wheelchair as requested authorization by Apria who attached my 2011"critically severe" sleep study as justification.

What I find amazing is that they actually think they can get away with it. Unbelievable... I wonder what it's going to take to stop this type of thing.

[tortoisegirl]

My DME refused to give me the non heated tubing that should have come with the machine (and which you need to use the machine without the humidifier) as they bill separately for it, same as they do for masks & headgear (although packaged together). They insisted the machines don't come with it. Maybe they do a case sale without it? It did come with the free carrying bag though; I'm surprised they don't try and charge for that. Probably only because their isn't a code!

Krelvin-It sounds more like they billed for a replacement cushion than a second mask, due to the price point. But they typically wouldn't do that with the initial setup as they don't know if you'll keep that mask. I'd fight that charge. The others look to be typical though. And yes, that is likely a one month rental charge, not the full cost of the blower unit. Ask your insurance how long the rental period is before it is yours to keep. Also, never pay at a DME unless you at least have an estimated EOB. It may be tough to get your copay back that you don't owe. As a start, I'd send the DME a copy of the EOB which says you don't have one. My DME actually doesn't request payment until after the EOB goes through. Easier for them I guess than having to give refunds or collect remaining balances, as the reimbursement rates are subject to change. Best wishes.

[Demerit]

In the box with the machine is either a heated tubing or a slimline tubing, not both. It all depends on how the dme is ordering. Both have their own bill code, so you can have both if you'd like.

[Sleepysuz]

The sad thing is that honest medical providers may have their paperwork scrutinized and not be doing anything wrong. A friend of mine fitted people with artificial legs and missed some detail on the paperwork. He had to immediately refund all the money and resubmit an appeal which could take a year. The people had their new legs but he didn't have the hundreds of thousands to cover the refund until being repaid. Had to close his practice. They pick on the little guys and the big machines have stuff slip through. I hate those commercials on that say call us and get a knee brace or electric scooter for no charge!

[Krelvin]

I just thought it was interesting what was billed. I had to wait for that to show up on the website so that I could discuss the copay issue with the Insurance since they said they had nothing to look at until that happened. Now that it has, I will find a time when I have lots of time and give them a call. The only thing that stood out to me really was the replacement mask.

I think the filter cost was amusing for what it is. I recently got 6 filters which had more substance to them for my old M-Series for less than the billing on that.

Not really worried about not having a regular hose as I already have several brand new ones that I could use should I decided to not use the Heated hose I got. During the summer I typically only use the humidifier on bypass mode due to the heat, but it is about to turn around here (mid-80's all next week Yea!) and will start getting to the time I would normally start using it with the lowest heat setting.

The DME's office is literally 2200ft from my front door, so not an issue if I need to visit them and discuss things for a while.

[Semily]

I think if the insurance was paying, it would be tempting to accept. I loathe walking through Walmart and have been really tempted on more than one occasion to get one of the scooters.