Insurance change- mid rent to own period

Been a long time patient and my PS1 550 auto gave up the goast. It has been over 5 years since the DME went through my insurance (BCBS) for a new machine and decided to start the process in September. My insurance now only does the 10 month rental before they pay for the machine from the DME, even though I have been on therapy >10 years. Fast forward, 45 days into the rental and I find out that my current insurance plan will not be available in January 2016 and will only be able to purchase a high deductible plan going forward. Lousy timing as I will be on the hook for the bulk of the DME inflated costs > $900 for a F&P Icon. Not happening. Almost a blessing as I wanted a PS1 560, but the DME dropped respironics for F&P.

So.... I Just picked up a new PS1 Auto Bluetooth package from the forum sponsor. The Icon goes back to the DME next week.....no sense keeping it any longer.... It was meant to be

Now I need to figure out how to update my profile and stay awhile.

Rob

Helps to be signed in

You are rushing into this.......Check with your current insurer to make sure that they will not cover a claim that was started while they were the insurer. Also....check to see if you can continue to make the remaining 6 payments on your own.

LSAT wrote:You are rushing into this.......Check with your current insurer to make sure that they will not cover a claim that was started while they were the insurer. Also....check to see if you can continue to make the remaining 6 payments on your own.

I disagree. They gave him a machine he doesn't like and he will be paying more for it then a new one he does want from our host. Even if he wasn't changing insurance companies he is better off financially.

When I started with new insurance I had three months to go on my rent-to-own period, and the transition was seamless. No hassles whatever; the new insurance picked it up for the last 3 months. Thus, I'd say find out from your insurance how they will handle it. BUT you've already assumed the worst and picked up a new machine so it's really a moot point now. Never assume anything without checking the facts if it's something of importance to you.

Sorry, I may not have explained the high deductible well....BlackSpinner is correct, Because the new insurance has a high upfront deductible of at least $3,000, I must pay the first $3,000 dollars after 12/31/15. The current insurance co will not cut a check for the machine cost until the 10 month rental is complete and successful. They wash their hands of me on 12/31/15 and will not cover the remainder of the therapy.

I would be stuck paying for the remaining 7 months rental out of pocket and the inflated machine cost charged by the DME next year, until my deductible is met.

Knowing this, I essentially saved $400 to $500 dollars by biting the bullet and purchasing a machine outside the DME / high deductible insurance today. Not liking the F&P machine over the PS1 platform was really secondary...I could have lived with the F&P, but figured I should be happy with the machine purchase since it was going to be out of pocket.

Except you won't be getting the discounted amount that the insurance company negotiated with the DME.

Buzzby wrote:Sorry, I may not have explained the high deductible well....BlackSpinner is correct, Because the new insurance has a high upfront deductible of at least $3,000, I must pay the first $3,000 dollars after 12/31/15. The current insurance co will not cut a check for the machine cost until the 10 month rental is complete and successful. They wash their hands of me on 12/31/15 and will not cover the remainder of the therapy.

I would be stuck paying for the remaining 7 months rental out of pocket and the inflated machine cost charged by the DME next year, until my deductible is met.

Knowing this, I essentially saved $400 to $500 dollars by biting the bullet and purchasing a machine outside the DME / high deductible insurance today. Not liking the F&P machine over the PS1 platform was really secondary...I could have lived with the F&P, but figured I should be happy with the machine purchase since it was going to be out of pocket.

With many insurance policies after the 10 month rental period, you own the machine without any additional payment. Have you talked to your insurance company?????? ALSO.....If you have insurance you would not pay the "inflated machine cost". You would pay the insurance company's negotiated price which can be much lower than what the DME charges.

All good points....I did talk to an insurance rep who indicated that I would not be covered the remaining 7 months and the insurance was indeed paying on a rent to own type arrangement - my mistake ....but here is the kicker, they claim the first 90 days is considered a trial period and their payment to the DME only includes costs associated with a normal rental. If I pass the 90 day compliance (end of December), the insurance would then begin to pay exponentially towards the purchase of the machine. All well and fine if the insurance was still in place come January, but the insurance change in 2016 kicks the bulk of the costs to the new insurance plan which I'm forced to pay the first $3000 out of pocket. Seems silly to lump a 10 year user into facing new patient compliance, but the DME claims this is how its done today with most insurers.

Now the DME is the stickler here; Their total billed cost on my agreement was over $1,300 of which I'm responsible for ~25% copayment. This amount was then split over 10 months for my payment to own outright. I had to sign a rental agreement that puts me on the hook for the full inflated cost of $1,300 if the insurance doesn't pay. I thought nothing of it.... not considering.... I could loose or have a significant change in coverage next year. I'm well aware this is totally a made up inflated number, but the DME has me over a barrel with the agreement and shows no interest in giving me the break today. Their tune may change once I produced the EOB statements next year, but waiting and the hassle just didn't make sense. It was time to walk away....I'm happy and the DME is cool getting their machine back.

Had I found this site back in late August and did my DD, I would have likely skipped the 25% deal and DME hassle upfront and just went out of pocket back then on the PS1 sale (assuming it was on sale back then). Better late then never and an ordeal that was a good learning experience.