Insurance and DME Charges - What's the Process/Scheme

After cruising along for nearly 6 months with insurance seemingly paying, I've found that I may be being taken for a a nasty ride. Let's see if this is regular process for new users (January 06):

-- monthly rental of CPAP unit and separate rental of humidfier,

-- after X months the DME charges for purchase of the unit(s),

(here's where it starts getting weird)

-- the insurance company adds up the rental charges to see if the purchase price equivalent has been met, and if it has, the purchase claim is denied.

-- the DME claims the one set of costs is rental the other is purchase and a circular argument is created with me owing (or maybe not owing) an unaffordable sum and, in the event the insurance co. acquiesces, my deductable that is met for this insurance year rolls back to unmet on July 1. Hmm seems like lose-lose for Chris.

?? Any suggested actions?

?? Is it advisable to think about turning the "rental" unit back to the DME; using the original (or new) perscription to purchase the same (or different) unit online for much, much less; then fighting the insurance over reimbursment. It seems there may be an economy even if the insurance paid at its non-preferred provider rate. Of course any rates become somewhat moot in 8 days with renewed deductable. Back to lose-lose and no vacation trying to pay for essential medical equipment.

Chris,

Have you been talking to your insurance provider about your options? I would suggest a conversation with someone in the supervisory/managerial level.
They've probably already paid a pretty penny for your rental so far, but you and they need to "push the pencil" and see which option is more advantageous for you AND them. I assume this is probably a group plan where you work....

Best wishes,

Den

Great post.

I was told that I should come back in 1 month to decide whether or not to buy or rent. Get this. I come back, and I'm coming back to see the DME at all. I'm coming back to see the Sleep doc! (One of two or three at this Sleep Center.) Surprise! He actually shows me a print-out of my sleep study. WOW! Prior to this I had to call and request "basic" data on the whole event. This printout showed alot more. They even tried a BI-Pap on me at one point but the Doc doesn't seem to think I need it.

Because of a mask issue (going from Swift to Activa due to sensative nares.) I was going to need a new mask and so the Doc checked to see if the DME was available. And before that occurred I mentioned I was supposed to decide whether or not to rent or buy the machine (or so said the DME.) He informs me as if it's matter of fact, that it's a rent to own deal.

Let me add to that, these Doc's have WAY too many patients. He didn't even remember that I had a new APAP and had replaced my CPAP. He was talking as if I still had the Remstar Plus M series. I informed him I was on the APAP now. And he quickly recalled my issue about drinking alcohol on occasion and needing more pressure. So apparently, he ok'd it on alcohol use ALONE. Interesting huh?

I'm not badmouthing my doc or DME. It's more of a system issue. They're just like me at work. Trying to give each customer the best assistance possible. But having to deal with so many people that it becomes impossible to remember each one. People get very mad at us because we're not more flexible when they have personal circumstances that keep them from paying their bill. We're not able to walk on water. And we do our best to educate when people assume to much and they usually do. People don't ask "can I do this?" They assume they can and when it comes down to it, they usually can't and get mad.

My end analysis is that as much as I like helping people I don't like a good portion of people in general. They're mean spirited and always trying to pull something over on us. Nothing seems to please them other than giving them exactly what they want. But they quickly find out when they go elsewhere that things are rough all over

First let me say oops! My post was intended to be a new thread, I wasn't trying to hijack. I'll move it to its own thread. Thanks for the replies nonetheless.

I'll move up the chain at the insurance company... and yes its a group policy/self-insurance through a secondary provider. The provider's corporate offices are local so I can camp out on a desk if it comes to that.

Let us know how it goes.