Insurance Problems

Hi all! Been a while since I've been around. Just a little update, I've been using my Resmed S9 ASV faithfully since March and everything has been going well. When they told me it was time to verify complaincy (May I think,) I brought my machine up to the Medical supplier (because they couldn't read the card I sent in the mail.) It ended up being a lengthy visit since they had to download new software to read the card, since apparently I must be the only one using the new Resmed S9. I also followed up with my doctor after that, like instructed, to say I was being compliant and using the machine.

For those of you that helped me, I'm sure you remember me asking lots of insurance questions and I thought I had everything worked out. Well, on Saturday I received an EOB from my secondary insurance (BCBSM) denying my coverage for March, April, and May. June was also billed, which they did approve and pay. I called BC this morning, trying to figure out where the problem was. The woman I spoke to was very helpful and after a while she finally figured it all out and broke it down for me.

March - the medical supplier billed it as an ambulance service and hospital stay?? Obviously an error so needs to be rebilled.
April - Compliancy for machine not shown - although they did get compliancy for the humidifier which they won't pay since they aren't covering the machine
May - Same issue as April
June - Compliancy shown, claim covered

So, apparently Blue Cross wanted to see that I have been compliant from day #1, but the medical supplier only showed I was complaint from June (after 90 days.)

Now, I know I have been compliant from day #1. The data on the machine will verify that, correct? So, the medical supplier can submit the information showing I was complaint from the beginning? The lady from BC tried calling the DME, but the biller wasn't in yet so she left her a message to call back. The lady from BC said she would call me back later to let me know what was going on.

* And I still haven't gotten an EOB from my primary insurance so hopefully they billed them correctly or I'll be on the phone with them too!

Get a copy or ResScan (pugsy can help with that), run off a report for the entire period, send a copy to the insurance company, and ask If they need anything else.

For personal data monitoring, SleepyHead may be just fine, but this is contractual stuff and needs the stamp of approval from ResMed that ResScan gives.

You can't depend on the DME to straighten this mess out.