Any Experience with Pacific Pulmonary Services??

Most private insurers work a lot like Medicare, but there can be infinite variations. Therefore, if you are not on Medicare, it’s extremely important that you call YOUR insurer and ask the following questions:

A. Does the insurer pay by HCPC code, or are only certain machines covered? If only certain machines, does it pay more for some than others? If the insurer covers only part of the DME’s cost, are you required to pay the difference between the insurer’s allowable cost and what the insurer pays, or between what the insurer pays and the DME’s retail price?

B. Does the insurer purchase the machine outright, or require a rental period?

C. What are your co-pays and deductibles? This is important! If a rental period spans more than one calendar year, your out of pocket expenses for co-pays and annual deductibles could easily cost more than buying the machine yourself online. Or, if you will be changing insurers, you could lose the “credit” for co-pays and deductibles already made or have to change machines. Make sure you understand all of this before you sign on the dotted line with a DME.

D. Does the Insurer cover only certain masks or all masks from the DME? Again, does the insurer cover supplies (hose, filters, masks, cushions and nasal pillows) by HCPC’s codes or have a limited “formulary” for supplies?

E. Does the insurer require you to use only certain DME providers, or will it pay for any DME company? Do you get better coverage if you go to a “preferred provider”?

F. What is the insurer’s schedule for replacement of supplies? Many, but not all, follow Medicare guidelines (2 nasal pillows or one mask cushion every 30 days, 2 paper filters every month. 2 foam filters every 6 months, 1 hose every 6 months, one new mask and headgear every 3 months).

Guest wrote: Boy do I feel sorry for you; that is who I had to go through also (back in March 2010) and they are very pushy. First I did not get a choice of machine (mine does not report data) and they will call you once a month and insist that you need to change the filters, mask/nasal pillows monthly and your hoses and headgear ever six months and if you tell them you do not want it they send it anyway. After finding this site and doing some research their pricing is high. Their billing is months behind. They kept telling me even if you do not need the supplies your insurance allows XX $ per year, so out the stuff would come. It took me 3 months and several phone calls to close my account and not have them call me. Do not be stupid like me see if you can find someone else to deal with. At least this was my experience with them. Still feel like a newbie; learning stuff everyday and LOVE THIS SITE!!!