Update on insurance and DME

Well, as it turns out, I was wrong, and BCBS of GA is NOT showing that I've met my deductible through my previous insurance. So, while I am waiting for them to get this mess worked out, I decided to call around to area DME's to see which one was willing to provide me with the machine I want....the Resmed S9 Autoset for her CPAP w/H5i heated humidifier. Turns out, that they are all saying that it has to be specifically prescribed and that it is special order only. One of the three I talked to said there would be a $200 upgrade charge. Well, I knew not to take this lying down. I spouted back to her that the billing code was E0601 whether its a cpap or an apap, and she said she didn't know if there was another code for the auto part or not, but company policy was to charge a $200 upgrade. I marked that DME off of my list! How do you fight them if the buck the upcharge thing?
I am going in well armed with LOTS of notes and alot of information so they don't take advantage of me! Hey, I'm in the business of marking up goods to sell to the public too. Even though I know even if we write a rx for eyeglasses, they are welcome to take the rx where ever they choose...they don't have to buy from us. They pay for the eye exam, and the rx is theirs....no questions asked. But, I also know how much more money we make when we buy a less expensive frame and mark it up a certain amount....same with the DME and the cpap machines...sure they wanna saddle me with a less expensive machine so they can make more money, but if someone comes in armed with info, then they should realize I'm not gonna be taken advantage of. I'm sure that most people go in to see their DME oblivious about everything and they trust they they're getting the machine and supplies that they need. Well, I know it's MY money and My rx and I can do with it what I please.
Heck, my husband is a doctor and can legally write me an rx for a cpap machine and I could order it on my own. I just need to find out whether or not I'll be able to file it on insurance for reimbursement with BCBS of GA. I'm NOT a patient person and this waiting is driving me nuts!!!!!

WalkingZombie wrote:One of the three I talked to said there would be a $200 upgrade charge. Well, I knew not to take this lying down. I spouted back to her that the billing code was E0601 whether its a cpap or an apap, and she said she didn't know if there was another code for the auto part or not, but company policy was to charge a $200 upgrade. I marked that DME off of my list!

WalkingZombie wrote: How do you fight them if the buck the upcharge thing?

Ask your insurance if they permit an upcharge. Most Do NOT.

Then decide if you need to pay the fee to report this to your Insurance Commission.

IF you mentioned where you are in this Universe someone might be able to offer specific ideas. IF you have mentioned this in one of your other threads then forgive me, did I forget to tell you I have a memory problem?

It's often a good idea to keep your posts in the same thread for those reasons.

Good Luck

LOL! I don't know why it's hidden from my info, but I'm in Georgia and have Blue Cross Blue Shield of Ga.
I too have had memory problems and being as my mom has alzheimers, I was seriously afraid I was getting it early. Turns out apnea is causing my memory loss and loss of concentration. That was a big relief!

I believe that Sleep Apnea also contributes to if not causes alzheimers. So we're both on the right track.

I have also read that it contributes to alzheimers. Before I was diagnosed, I was certain I did NOT have apnea! I didn't have any of the typical symptoms, no snoring, no waking up gasping for air per my husband, etc. The only reason my doc sent me for a sleep study was because of my daytime sleepiness. I'd sleep whenever and wherever I could. I never could get enough sleep. But, I thought I was sleeping like a rock at night. Well, I was eventually diagnosed with severe sleep apnea. I am still a little shocked and sometimes wonder if they mixed up my test results with someone elses. But, after I was diagnosed, I started learning all I could about OSA and realized that my loss of memory and lack of concentration could be attributed to it. All the puzzle pieces seem to fit, it was just hard for me to accept. I was the last person I ever thought would be diagnosed with OSA I thought the doc was barking up the wrong tree.

WalkingZombie wrote:But, I thought I was sleeping like a rock at night.

I told the sleep tech I have no trouble sleeping, whenever I stop moving I fall asleep. lmao

Denial is the first hurdle to conquer is the OSA battle.

See "Don't pay that upcharge" in my signature below. Check with BCBS and ask if DME providers may charge you more than the allowable fee and require you to pay the difference. My blog also gives you a link to check your state law for "balance billing" practices. Remember if you have a BCBS HMO plan they may contract for only specific machines rather than by hcpcs code.

Balance Billing
http://healthinsurance.about.com/od/cla ... illing.htm