Insurance Change During Rental Period

I've just learned that my employer will be changing insurance providers effective Dec.1. At that point, I will be 7 months into my 10 month rent-to-own period on my machine. Does anyone have any experience with changing insurance providers during a rental period? What should I expect? Am I going to have to return my machine and start all over under my new insurance?

I've got an email in to my employer's insurance agent, but any advice on how to proceed or experiences shared would be most welcome.

The Latinist wrote:I've just learned that my employer will be changing insurance providers effective Dec.1. At that point, I will be 7 months into my 10 month rent-to-own period on my machine. Does anyone have any experience with changing insurance providers during a rental period? What should I expect? Am I going to have to return my machine and start all over under my new insurance?

I've got an email in to my employer's insurance agent, but any advice on how to proceed or experiences shared would be most welcome.

If you are in the middle of a a therapy, you can normally get an extension with the old insurance to cover the final 3 months. You need to contact your current insurance company as soon as you know of the issue (which is now).

I had this for a medical procedure which took 4 months to prepare for before the procedure itself. It was covered 2 months after the change over but was covered by the old insurance. This was 3 years ago, so things might have changed but I kind of doubt it.

There are a number of things that could change--you need to know how the new plan pays
(rental or outright purchase); there could be new deductibles due, or your
current machine arrangements could be eligible to be grandfathered.
Good luck.

Usually the rental continues under the new insurance up to the new insurance contract price. In other words all monies paid under insurance 1 get applied to the contract price of insurance 2.

Interesting question for me too since I will be in the same boat as of Jan 1 2015 - 7 months in on a 10 month rent-to-own type of deal and transferring to a new insurer. My problem is the scam that this DME's billing is pulling every time I get supplies (not unlike every other medical product or service provider I've dealt with recently). $100 line item for a two pack of PRS1 ultra fine filters. $250 line item for a two pack of cushions.

They have assured me the deal will be negotiated with a credit for what's already been paid. My concern is they will find a way to stick me with 30% copay on a machine priced at 5 times market value. They have been advised of my plans to go elsewhere if more shenanigans occur.

Watch out for this DME trick:

Your old insurer pays a "capped rental" for 10 months and you change insurers after 7 months. Your old insurer has paid 70% of the entire capped rental contract, after which the machine should have been YOURS. Now your new insurer requires a capped rental of 13 months (or whatever). DME charges insurer (and you are expected to pay the co-pay) for 13 additional months on the same machine. Ding, ding, ding, the DME wins big--double what it would have gotten if your insurance didn't change.

Buzzz! You LOSE. Especially because a large chunk of the additional 10 months (13 months for the new insurer minus the 3 months left to go on your old insurer's contract) may come directly out of your pocket to meet a deductible.

Don't let this happen to you. You are going to have to be proactive--get the facts and don't let the DME screw you. Start with your old insurer to see how they suggest handling it. Then talk to the new insurer. If necessary, get your HR department at work to advocate for you so that you don't have to get cheated because of the switch in insurers. Don't even bother with the DME until you find out what the insurers can do to avoid this situation. Then talk to the DME with a plan--either they will consider the rental done when the original 10 month contract is up or they will give you a brand new machine or you will go out and buy your own machine for probably less than you would spend with the DME for the other two choices.

Good advice, I was pondering a scenario like this today after hanging up the phone with the shady DME. I have a few months more to get it together. I have access to a flex spending account if I wind up going on my own too which is nice if I get hit with deductible or co-pay on something new. I'll get a brand new machine if I have to just because I get so pissed at all these shady billing tricks.

Amenite wrote:Interesting question for me too since I will be in the same boat as of Jan 1 2015 - 7 months in on a 10 month rent-to-own type of deal and transferring to a new insurer. My problem is the scam that this DME's billing is pulling every time I get supplies (not unlike every other medical product or service provider I've dealt with recently). $100 line item for a two pack of PRS1 ultra fine filters. $250 line item for a two pack of cushions.

They have assured me the deal will be negotiated with a credit for what's already been paid. My concern is they will find a way to stick me with 30% copay on a machine priced at 5 times market value. They have been advised of my plans to go elsewhere if more shenanigans occur.

You will only pay your 30% co-insurance on the insurance negotiated price, not the list price (and keep in mind that co-insurance is after any deductible you may have has been met). I found my insurance negotiated rate was only slightly higher than online prices. The list prices really mean nothing to the patient. What you need to look at is the amount your insurance shows as having paid on your Explanation of Benefits. However, often you can't find this information ahead of time, only after the claim has been submitted & paid by the insurance. Agreed though you need to get info straight from your new insurance on how they will handle you having an outstanding rent to own on your machine. Preferably, their printed policy on DME. Best wishes.

Amenite wrote:$100 line item for a two pack of PRS1 ultra fine filters. $250 line item for a two pack of cushions.

I purchase my ultra fine filters out of pocket, $50 for a pack of 100, IIRC.

I am in the same boat with my Medicare Advantage Plan. I will be 12 months into a 13 month rental. Unfortunately my plan is NOT rent to own. after 13 months the DME still owns the machine and goes to a maintenance fee every 6 months eqaual to what the rental was per month.
The problem is up until now my plan paid 100% of DME $499 or less. My 20% copay does not kick in until the cost =$500, when I pay 20% of the total.
Next year 2015 my plan changes to 100% up to $99. At $100+ I pay 20% or the total. In my future I don't see any masks, hoses or filters any less than $100.
My rental on the machine is $393/month for a $3600 ASV machine. At 13 months rental Crapria has already overcharged for the machine. Has anyone ever seen a DME provide any maintenance on a PAP machine? By the end of year 5 they will have collected maintenace fees equal to 75% of the value of the machine, for absolutely nothing.

If I change insurance Crapria has already assured me, they will want this machine back, and I will start fresh.

and autoSVs are only 1300$ on secondwindcpap.

At this point I am thinking about seeing if I can just pay off the contract price under the old contract before my current insurance expires, even if it means I have to pay a couple of months' rental. Honestly, I just want to be done with my DME once and for all. If at all possible I will buy my next APAP outright.

The Latinist wrote:At this point I am thinking about seeing if I can just pay off the contract price under the old contract before my current insurance expires, even if it means I have to pay a couple of months' rental. Honestly, I just want to be done with my DME once and for all. If at all possible I will buy my next APAP outright.

Probably a good plan. If you can get your (old) insurance provider to help with a payout of some sort, too, that would be the way I'd go. The overlapping deductible periods are usually something most people don't consider in their contracts.......and then if the insurance providers decide to change the rules in the middle of things, that screws things up, too.

Good luck.

Den

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Wulfman... wrote:Probably a good plan. If you can get your (old) insurance provider to help with a payout of some sort, too, that would be the way I'd go.

Yeah, I'll call Anthem tomorrow and try to get them to pay up. It's not as though I wasn't diagnosed on their watch, and I've been 100% complaint over the last five and a half months.

Medicare has a mandatory rental of certain DME equipment for so many months and then you are given a choice of whether you want to purchase or if you want to continue to rent the equipment. The DME is suppose to send you a letter that gets your signature stating which you want to do. (Unless it has changed in the last few years). If you choose to purchase, the DME does not get to send a maintenance charge to the insurance every 6 months. If you rent it, then they do even if they don't have to do any maintenance. That is the way the insurance requires the DME to do it. Medicare HMO's may follow the same or they may be a little different as each plan can differ. Do NOT take the DME's word on how your insurance does it. ALWAYS call the insurance yourself. Don't worry about what the billing cost that the DME sends to your insurance. The insurance has an allowable and they will pay according to that. The difference between the allowable and the billed cost is written off by the DME. They can not charge you that difference. You will find this information on your EOB (Explanation of Benefits) that the insurance company send to you. The DME can only charge what is listed on the EOB as the patient responsibility ( which is usally your 10 or 20%).

For the original poster here, do not accept what your new insurance agent or representative tells you. Get a phone number of the new insurance and call them. Most insurance agents do not understand what is covered and what is not. They have no personal experience with billing equipment. In my experience, most new insurances will continue the rental but the DME must bill it to them correctly with all the needed info (like proof of compliance and what month you are on, etc). I seriously doubt you will get your current insurance to pay for the rest of the months but it would be nice.

From an EX- DME biller.....