1 year fight with cpap supplier--Is this correct?!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Ami_ga
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Ami_ga » Wed Sep 28, 2022 1:52 pm

ChicagoGranny wrote:
Tue Sep 27, 2022 3:11 pm
Why can't you prove compliance? Do you not know how to print a report or, better yet, save the report to the file and email it to the supplier?
It's not that I can't show my insurance that I'm wearing it every night. My insurance company isn't even asking me for that data because I'm in my 8th year of cpap therapy. It's that the seller of this particular cpap (Rotech) is claiming that my insurance company is making THEM charge me a rental fee each month until I have "proven my (usage) compliance" which happens to be 10 months, apparently. So 10 months of rental fees despite me having met my deductible as well as my max out of pocket medical costs at the time that I was trying to purchase this replacement cpap. So Rotech should have sold it to me as a PURCHASE rather than as a rental. That way, my insurance would have paid for the entire thing. And each time I have called my insurance customer service, they have told me I am correct and Rotech is wrong. But Rotech billing refuses to accept that they are wrong, and they keep billing me and are now threatening to come take the cpap from me.

Ami_ga
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Ami_ga » Wed Sep 28, 2022 2:00 pm

ChicagoGranny wrote:
Tue Sep 27, 2022 3:11 pm
Why can't you prove compliance? Do you not know how to print a report or, better yet, save the report to the file and email it to the supplier?
Janknitz wrote:
Tue Sep 27, 2022 7:11 pm
Full stop.

Have you seen your insurance company's policy in writing?...
Wow! Thank you very much! I never would have thought to ask for this! I'll get right on it. Thank you so much!

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ChicagoGranny
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by ChicagoGranny » Wed Sep 28, 2022 2:05 pm

Ami_ga wrote:
Wed Sep 28, 2022 1:52 pm
It's that the seller of this particular cpap (Rotech) is claiming that my insurance company is making THEM charge me a rental fee each month until I have "proven my (usage) compliance" which happens to be 10 months, apparently.
Gotcha!

I would ask to speak to a manager at my insurance company. Insurance companies have quality control processes that include regular reviews and ratings of companies in their networks. It is important for DMEs to remain on network lists. When Rotech gets a call from a manager at the insurance company, they might jump through hoops to settle your complaint. I've had it happen.

lynninnj
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by lynninnj » Wed Sep 28, 2022 2:09 pm

My experience with Cigna is that they are pretty awful.

YMMV

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Janknitz
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Janknitz » Wed Sep 28, 2022 5:45 pm

Wow! Thank you very much! I never would have thought to ask for this! I'll get right on it. Thank you so much!
Most people have never seen the EOC unless they know to ask. I don't get how insurers get away with this, since the EOC is the contract, and a contract requires a "meeting of the minds" about what the contract is. If people don't understand their rights, duties, and exclusions under the contract, how can they be held to the terms??? I've never seen any literature when I signed up for a health insurance even referencing the EOC. But if you ever want to appeal an insurance denial, this is the starting place.

I helped someone whose father committed suicide, but he didn't die quickly. He was in a coma in ICU for 13 days before he died. The insurance company wanted to deny coverage for his ICU care because it was a "self-inflicted injury", and it was a huge bill. But the EOC did not contain an exclusion for self-inflicted injuries, and when I pointed that out, their lame answer was "well, we usually exclude them". :roll: They paid up.

In your case, it will be a starting point to see who is lying (my money is on the DME) and who to push on once you know the actual policy and can show it in black and white.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
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Ami_ga
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Ami_ga » Wed Sep 28, 2022 5:54 pm

Is Rotech the only supplier Cigna has a contract with? Ask your Cigna rep if you can get a machine from another supplier and tell Rotech they can have their machine back due to their billing errors.

No, there are other suppliers here, but nobody else could get their hands on the popular Resmed machines at the time. And that would be hysterical! I should do that!! :lol: However, that just means Rotech will continue to mess up billing for other patients, and that erks me. (IF my EOC does indeed show that they should never have charged me rental fees. But even if I DID have to "rent" instead of "purchase," it was only for 6 months total, not 10. So just 2 months in 2022 (not 6) when my deductible started over at the new year.) Oh, and an update for @Jlfinkels: I chatted with a Cigna rep and got the runaround again. But this time was told that 1) "Well, if this is your SECOND cpap, and it is REPLACING your first and not part of a recall (since I didn't go through Philips), then YOU are responsible for the ENTIRE COST of the machine because Cigna only pays for your FIRST machine that you rent for 6 months. WHAT?! She pulled that one out of her arse! And 2) then she said that I had supposedly used an out-of-network cpap supplier, so THAT was why I was being charged. :lol: (I had NOT! Rotech is listed on their in-network list of "pap suppliers" for MY particular policy). So it's clear I am going to get absolutely nowhere with either the supplier or the insurance company until I get my hands on that EOC. I tried getting it from the Cigna gal or having her show me where I could access it, but she just kept sending me copied and pasted portions of it, none of which gave me what I needed, anyway. None even had the word "cpap" in them. :roll:

I called the DME where I got the Phillips machine but they couldn't get a ResMed machine. So I called a DME closer to me who happened to have contracts with ResMed and got a new AirSense 11 within a month or so. Me, too. Only 1 provider in my area had the Resmed Airsense 11 that my dr preferred and they were down to the last few. Also I have only received one letter from Philips about the recall and don't intend to request a replacement from them. Not when I already have a machine and so many others are STILL waiting.

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Jlfinkels
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Jlfinkels » Wed Sep 28, 2022 6:01 pm

Ami_ga wrote:
Wed Sep 28, 2022 5:54 pm
Also I have only received one letter from Philips about the recall and don't intend to request a replacement from them. Not when I already have a machine and so many others are STILL waiting.
My opinion is you should fill out the paperwork for the Philips replacement machine. Worst case you have a backup machine, best case you can donate it to the Reggie White foundation for someone who cannot afford one. You will automatically be placed at the end of the queue so it will not impact others, but you can also go to the patient portal prioritization page and put yourself at the back of the queue as I did.

FWIW with Cigna, get to someone above the front line support. Explain the situation and hope for a better outcome.
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Ami_ga
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Re: 1 year fight with cpap supplier--Is this correct?!

Post by Ami_ga » Wed Sep 28, 2022 6:05 pm

[/quote]
Gotcha!

I would ask to speak to a manager at my insurance company. Insurance companies have quality control processes that include regular reviews and ratings of companies in their networks. It is important for DMEs to remain on network lists. When Rotech gets a call from a manager at the insurance company, they might jump through hoops to settle your complaint. I've had it happen.
[/quote]

Yeah, I should have waited for my Cigna customer service warrior who won't be back in the office til tomorrow. She is not a manager, but she demanded that Solara apologize for sending me to collections over their own dang error! I kept calling and calling and they'd never answer their phone. Just kept sending me nasty grams and eventually I got a letter from a collections agency! Over an item I had never ordered from Solara. 2021 was not a good year for me with all of the billing nightmares. I'm just wondering how many others slipped through in years past? That we paid without realizing they were errors?!