So.... 2 DMEs walk into a bar....

Janknitz wrote:Resmed S9 Autoset's billing code is E0601.

Prepare a letter to the DME that you understand, after checking with your insurance company, that the DME is not permitted to balance bill. You also understand that the billing code for the machine your doctor has ordered, a ResMed S9 Autoset, is E0601 and that your insurance covers the cost at 100%. You expect them to provide the machine requested, and if they attempt to bill you for more than the contracted insurance price you will be filing complaints with your insurer and with the appropriate state regulatory agencies. Fax or mail it to them and tell them what time and day you will be coming in to pick up your S9 Autoset.

If and when they do provide you with a machine, check and double check to be certain that it's really the Autoset, not an Escape Auto--odds are 50:50 that they'll try that trick.

Thank you for the confirmation on the billing code.

I am prepared to confront the DME if necessary. By way of preparation, I spoke to yet another DME today, explained my problem, and was told that not only do they have the machine in stock, but that they accept my insurance as 100% payment. This would be after they confirm my coverage plan naturally. Basically the person I spoke with at this other DME said they can't balance bill with this insurance plan (mine) and that they handle this sort of thing all the time. She said, "The simple fact is that some machines are more profitable than others. This is true in any business, don't you think?" .... so.... some actual LOGIC from a DME?

I forgot to ask her if it was dark outside....... next time....

Anyways, I think I've done about all the leg work I can do until I see this new sleep doctor. Hopefully he'll see things my way. And if not... I'll find yet another sleep doctor.

Imagep,
Well Said. Trying to figure out how to post that to fb! When I got out of the military I was amazed at the things people went to the doctor for, because their copay was less than they would pay for OTC meds. I said the same thing, It's like having oil changes paid for my your auto insurance. Where is this dr's office? I know more and more docs are going that way but you never find them because the insurance company has everyone afraid to go "out of network". My dr is part of a hospital system so his job is to refer me for other procedures at the hospital.

One of the things that really torques my jaws about today's healthcare system is w/the hospitals crying poverty - and all the while they are building new campuses for outpatient care, new offices for doctors to practice in various areas of the county or city. If they are so freaking broke where is all the money for these extravagant buildings and campuses coming from?

yardbird wrote:I forgot to ask her if it was dark outside....... next time....

I think the saying is very applicable in this situation. Buy the machine from the good DME, but check that it really says AutoSet when you get it. And that you're not signing up for balance billing.

Slinky wrote:One of the things that really torques my jaws about today's healthcare system is w/the hospitals crying poverty - and all the while they are building new campuses for outpatient care, new offices for doctors to practice in various areas of the county or city. If they are so freaking broke where is all the money for these extravagant buildings and campuses coming from?

Yup. About 10 or 15 years ago our local newspaper published the local "public" hospitals financials. Turns out they had more cash in the bank than it would take to operate the hospital for two years even if no one paid a penny. they saved up so much cash because they were making huge profits. Immediately after that the hospital started buying up local independantly owned doctors offices. Now almost every medical care provider in our county is owned by one of the two local hospitals. I suspect they started doing this not so much to reduce competition, as it was just a way to spend money so that they wouldn't be attacked for having so much cash. Eventually they started branching outside of the medical field, even starting a "business managment" division where they would manage unrelated businesses for a fee.

Ultimately the business management division died, as it turns out, hospitals don't really know a lot about managing businesses that have to operate under capitalism.

the year after the financials were reported, the newspaper requested updated financials, and the hospital refused to provide them. they said that although they were chartered by the state, and operated as a non-profit, they were not actually part of the government and did not specifically exist as a charity so they claimed that they were exempt from any requirements to report financials.

Our medical facilities have plenty of money, but they know if they poormouth they can justify rate increases. After all, who doesn't want a raise?

I'd throw my business to the DME that has no problem providing the Autoset. And send a polite letter to the balance billing DME about why they won't be getting your business.