HELP!!! DME/Insurance Company Problems!

Folks:

I Purchased a new Bilevel machine from my DME in December 2004, and Keep getting bills for a rental on said machine. The DME says that this is what the insurance company's preference. Insurance Company says it's not so...but they keep paying the bills for a rental and charging me a patient Share.

Neither the insurance Company nor the DME want to talk to each other...I am stuck in the middle with the potential of having to to pay out of pocket because the insurance company is ready to refuse payment because of some procedural errors on the DME's part.

Why does something as simple as purchasing a BiPAP from a DME have to be so complicated? Send my insurance company a bill for the inflated price, I'll pay my 20% end of Story! Instead my DME has initiated some Scam so that the machine is double billed! Rented for a year THEN purchased.

Anyone know how I can end this insanity? Alll I want to do is pay my bill for the outrageous cost of the machine....once not twice. Do I contact the Dept of Consumer Affairs??? Neither the insurance company nor the DME wants to provide documentation in support of their position! Each one is pointing the finger at the other. Care coordination recomends a conference call, but that would be very difficult because there are about 9 different menues to traverse through to get to them.

Anyone have any advice...besides the obvious one to purchase 100% of my supplies from CPAP.com! H-E-L-P!!!

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, cpap.com, DME

The DME wants you to rent....they get more money that way. Most insurance companies have a period of time that they pay rental until you prove necessity and compliance. My BCBS pays rental for 10 consecutive months. After 10 months, BY LAW (according to BCBS), the DME must ask you if you prefer to continue rental or purchase. My DME point blank told me that they will not contact the insurance. Soooooo, you need to call your insurance. They SHOULD have in their employ a NURSE mediator who you can speak to and get this resolved. I called BCBS and followed up with a letter. I received a telephone call within a matter of days. They told me to provide them with a Letter of Medical Necessity (which you can get from your doctor. Trust me, they print them out by the zillions.) They also need proof of compliance. In other words, they do not want to pay for something that you are not using. If your machine has a card in it, request a download from the DME. If they are a*******, call your doctor and ask him to order the download. The DME MUST provide you with a copy. By law, they have to give it to you. You have access to all your medical information!
Basically, you keep calling the insurance and talking to people until you get one who gives you what you want. To get through the menus quickly, ignore all instructions and keep hitting the star button until you get a real person ...we will assume they employ real people!!
Good luck! I understand your frustration and so do a few million other people!

_PS Get your insurance to send you a letter of preapproval to do an online purchase. Give them a breakdown of costs for all the equipment you need. BCBS approved mine with no sweat. Lots cheaper but be sure you have resources for help with the machine. Luckily, I found out my doctors office will check and set your machine! Just be sure everything is in writing and keep copies!________________

CPAPopedia Keywords Contained In This Post (Click For Definition): DME

My plan if my DME would become difficult (they did not - good dme) was to walk in and hand them the machine; tell them the rental is over?

Many different dme's in town and on line. Aint it your choice where you get if from?

2listless has correctly pointed the pathway to get out of this mess. Work it out with the insurance company. Consider buying the machine from cpap.com if that path is the least expensive. Support is really not an issue. Cpaptalk is better than any DME could ever be.

Guys:

This is the point....I have had OSA for 5+ years, and to the best of my knowledge was purchasing a replacement machine. There is no rent until there is proof of compliance since I have been purchasing supplies from this DME for 2 years. If I wasn't sure of weather BIPAP was working for me then what did I do with all those masks, tubing, chinstraps and head

I have sent letters to BOTH my insurance Co with a copy of the invoice I got when they mailed the unit to my house that indicated that the unit was sold to me outright. Yet the DME says that the rental is my insurance Companies preference. My insurance company's claims care and customer service says this isn't so, yet the letters dialoging this are not working.Meanwhile....why doesn't ME the consumer have a choice?I never signed andy agreement to rent anything, I specifically asked them to Purchase a machine for me with my doctors prescription. The customer service person who ordered the machine knew it was a replacement and wasn't my first BIPAP machine, and that I was a veteran user if the equiptment. All of the accessories were billed direct....the machine was not.

The problem I have with my insurance Co is that claims care does not have a copy of my bills and the claims department doesn't know anything about why there is a rental going on. Both suspect shenanigans...yet either is not willing to call my DME. They want me to set up a conference call.
Seems to me...my insurance Company is Clueless, and My DME is preying upon their stupidity. I am in for 20% of this Debocle!

List the topic of the certified letter on the green envelope ("request to stop payment of DME for CPAP rental"). Send one to the DME and one to the insurance company, and give them each a copy of the other letter.

A signed receipt of a letter is legally binding.

Then, if your insurance company pays for DME services you are not receiving, that's their problem (if I understand your dilemma).

Refuse to pay any premiums associated with the erroneous billing, and go ahead and buy your CPAP from CPAP.com through a sympathetic doctor and have them chase the insurance money for it (but good luck -- I haven't had much luck!)

What a lousy system we all have to contend with -- my sympathies are certainly with you

Hopeful

in addition, I'd also contact the Better Business Bureau and the Doctor who referred you to the DME to let them know what is going on.

Yes, please tell the doctor that sent you into this mess. He or she is recommending the WRONG DME. Perhaps it will save someone else from such trouble.