I still smell a rat. If there's no modem on the machine (which is why the DME needed her data card) there's no "monthly monitoring going on, so the DME can't capture anything out of the air.GTOJim wrote:Sorry for taking so long to update. The name of the DME is Oxygen Plus located in Walnut Creek California.
The DME has a legitimate way of billing monthly for data downloads which the insurance company does allow.
After spending a very long time discussing the issue with my wife's insurance, with very few exceptions, insurance requires some form of monitoring. I didn't get the full description but the partial is " Monitor Feature/Device Sent One Integrated" with something about monitoring internal electronics and items attached to the machine. The supervisor did not know if this monitor was something attached to the machine or integrated. She only knows what's on her computer screen.
The charges on my wife's bill from the DME are described as Data Management and Download. Maybe the DME uses this description as its' easier for most people to understand rather than the insurance companies definition for the billing code the DME is using.
Before speaking with my wife's insurance, I had a face to face with my wife's DME which was pretty interesting.
I started with a compliance print out and asked what was missing that the insurance requires? (originally told, software at home could not provide all requirements) My question caused quite a bit of confusion, I had to repeat the question several times, followed by a couple minutes of whispering while I stood at the counter watching. Eventually the printout was taken to a back office, after a couple of minutes I could hear raised voices. The printout returned 15 minutes later, I was told my report was for 30 days, the insurance also requires 90 days. I said no problem I can include a 90 report. Then a different person explained, my wife's insurance company requires the use of the DME's software only and will not accept any reports from me.
Ok I've got two more questions. How long have you been billing my wife for data downloads and please explain charging monthly fee's for something you did twice in one year? (DME requested my wife's SD card twice in 12 months) The first answer was the the SD card and the CPAP have different billing codes and have to be billed separately for ten months. I responded billing monthly for an SD card which comes with the machine, I've never heard of such a thing. At this point the young woman was obviously getting very flustered, turned to her co-workers practically begging when she asked for someone to help her out. Then I'm told my wife's medical group requires the DME to bill her insurance company monthly for downloading the data from my wife's SD card.
Very smart group of people, they apparently knew all this information about her medical group and insurance without looking any of it up.
On the drive home thinking about the DME, I found myself getting angry and called my wife's insurance.
Monthly charges seem fraudulent. "Some form of monitoring" may be to check the usage data on the card at certain intervals. Often it matches Medicare requirements (e.g. after 90 days and I think yearly thereafter). I highly doubt the insurer requires monthly monitoring, and unless it's a perpetual rental, there has to be an endpoint to the monitoring requirement.
If your DME charges you to download your data and downloads it twice a year, then that's what you should be billed for and only if the insurer will not accept it from the doctor (you can furnish the report to the doctor) or directly from you. And, if they require it, it should be a covered service.
