LATE INSURANCE PRE-AUTH BY CPAP PROVIDER

I recently discovered that my durable medical equipment provider delayed my CPAP Pre-Auth to the tune of 5 months. This resulted in my paying the full amount for the first 5 months, and extended my rent-to-own period by 5 months, which will increase my out of pocket by about $450 - almost half the price of a new machine. And all I got from them when I called and asked for an explanation was rudeness, "not our problem" and dead air.

Makes me wonder if the delay in obtaining pre-authorizations might be deliberate, since any provider would know full well that a large number of customers will be too busy, too wealthy, too dumb or too focussed on their infirmities to notice that they were paying for something that was supposed to be covered by insurance.

Has anyone else had a similar problem with their CPAP provider?

And would it surprise anyone that the provider in question also happens to be fighting a class-action lawsuit for deliberately orchestrating overpayments for another kind of medical device.

If you have evidence they were deliberately delaying seeking the authorization, you can file a fraud complaint with Medicare if Medicare is your primary provider, and with your supplemental insurer or other insurer if you're not on Medicare. You can also research to find out who regulates DME's in your state--in California it's the California Department of Health Care services, for example, and file a complaint with them.

Keep good notes--copies of ALL documents, date, time and who you spoke to if you speak to anyone, and send confirming memo to the entities you speak to--e.g. to the regional manager of your DME about the response when you called. "On December 19, 2023, I spoke to Bart Simpson from the Springfield billing department of Stupid DME to find out why the billing was not submitted to my insurer for 5 months. He replied "not our problem". Please either confirm in writing within 5 working days of this email if Mr. Simpson's statement is correct so I can relay that in my complaint to the regulatory agency or tell me to whom I should direct the complaint if not your billing office."

jasg wrote: ↑

Tue Dec 19, 2023 6:14 pm

Makes me wonder if the delay in obtaining pre-authorizations might be deliberate

Most DMEs are too incompetent to pull off a scheme like this. Incompetence runs rampant in this industry. Who is your DME?

jasg wrote: ↑

Tue Dec 19, 2023 6:14 pm

Has anyone else had a similar problem with their CPAP provider?

Our members have had every problem imaginable and many unimaginable.

BTW, we can read standard print sizes and even zoom in if there is a problem.

Sorry that you got screwed so badly.

You forgot the Cardinal Rule when dealing with DMEs.

NEVER ALOW YOUR DME TO HAVE ACCESS TO YOUR CREDIT CARD FOR ANY REASON.

I always have my bank mail them a check. I don't even want them to know my checking account numbers.