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Re: Monthly Data Download Charges
Posted: Mon Aug 29, 2016 6:03 pm
by Janknitz
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.
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.
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.
Re: Monthly Data Download Charges
Posted: Mon Aug 29, 2016 8:13 pm
by LSAT
I agree it's a sham....Medicare would not allow this charge and you definitely should not pay it.
Re: Monthly Data Download Charges
Posted: Tue Aug 30, 2016 2:50 pm
by GTOJim
I agree these charges do not seem proper, the billing code is legit, the insurance is approving and paying the charge.
I spent a great deal of time speaking with a supervisor, basically said, I believe these charges are bogus, if the DME is billing 2 or 3 thousand other clients for this service then it is a big number. I do not know how many clients they have, just making the point.
The supervisor offered to conference call the DME, I declined, the DME lied more than once, without more information the supervisor wouldn't be able dispute anything the DME stated. The supervisor could not even determine if the CPAP was paid off after 13 months, said the rental period is 10 months, first month billed was July 2015.
I also used this DME for a short time.
September/October 2014 I relieved a bill, no detail, only the amount due. Called, most charges were a year old, I questioned a 2014 charge as I did not order anything in 2014. They stated March 2014 I ordered a cushion and filters, my insurance was billed and they paid the charges. The promised call back did not happen, I paid the bill, possibly an honest billing mistake which I couldn't prove either way, I felt the other charges were probably legit.
Crap.. Crap... Crap... While making this post I realized due to the medicare competitive bidding program I changed DME's So it must have started 2014. Medicare would not have paid that DME for CPAP supplies ordered March 2014.
Re: Monthly Data Download Charges
Posted: Tue Aug 30, 2016 3:05 pm
by GTOJim
My wife is not yet on Medicare, she's 8 years younger than I am. I should have included this in my previous post, sorry.
Re: Monthly Data Download Charges-Updated
Posted: Sat Sep 17, 2016 1:59 pm
by GTOJim
The DME just sent a letter stating:
Data Management and download does not have a capped rental with Blue Shield. As an office we have decided to cap the rental on this item as a courtesy to our patients.
Re: Monthly Data Download Charges
Posted: Sat Sep 17, 2016 2:43 pm
by chunkyfrog
How thoughtful of them!
Re: Monthly Data Download Charges-Updated
Posted: Sat Sep 17, 2016 2:47 pm
by palerider
GTOJim wrote:The DME just sent a letter stating:
Data Management and download does not have a capped rental with Blue Shield. As an office we have decided to cap the rental on this item as a courtesy to our patients.
how can you 'rent' a charge for a service that's normally free?
Re: Monthly Data Download Charges
Posted: Sat Sep 17, 2016 3:40 pm
by chunkyfrog
My thought exactly.
So they capped it at WHAT?
A penny is too much.
Re: Monthly Data Download Charges-Updated
Posted: Sat Sep 17, 2016 3:55 pm
by palerider
GTOJim wrote:The DME just sent a letter stating:
Data Management and download does not have a capped rental with Blue Shield. As an office we have decided to cap the rental on this item as a courtesy to our patients.
you
have informed them that you decline their future offer of 'services', right?
Re: Monthly Data Download Charges
Posted: Sat Sep 17, 2016 9:30 pm
by library lady
My machine has no modem, I've never been asked to take the SD card in. Twice in 2 1/2 years I've been asked to bring my machine in when I come for a mandatory check-in... to the sleep clinic. My DME has nothing to do with that reporting. They do take the machine away from me for a few minutes, and that is when they check the data. They know I have SH to check my own data, and they don't have a problem with that. The last time they called me for getting a new RX they just asked me a few questions and based on my answers said I didn't have to come in, they would mail the new RX.
Something's fishy with this Data Management charge, as you've already determined. I would try to find a different DME.
Re: Monthly Data Download Charges
Posted: Sat Sep 17, 2016 9:31 pm
by palerider
library lady wrote:Something's fishy with this Data Management charge, as you've already determined. I would try to find a different DME.
+1
Re: Monthly Data Download Charges
Posted: Sun Sep 18, 2016 8:46 pm
by GTOJim
palerider wrote:library lady wrote:Something's fishy with this Data Management charge, as you've already determined. I would try to find a different DME.
+1
My wife has two choices for DME's, Oxygen Plus or Apria. Apria's local branch is so bad it's not an option. On Sept 7th she opened a dispute with her insurance regarding the cost of her CPAP, the insurance will respond within 30 days. If she has been over charged I will update.
Regarding download charges for the month of June the DME used a different code to bill her insurance than in any of the previous months, charging a few dollars more. Her insurance has allowed this charge and paid their portion to the DME. I would be tempted to call and find out the insurance companies definition for the billing code but I've already spent a few hours on the phone with her insurance over this issue.
Three years ago I purchased a BiPap from Oxygen Plus with Medicare, there were no download charges at that time. Maybe they found a loop hole since then.
If you have a removable modem, remove it!
Posted: Sun Sep 18, 2016 9:36 pm
by D.H.
At least this will prevent new charges from accruing while your dealing with this.
Re: If you have a removable modem, remove it!
Posted: Mon Sep 19, 2016 10:52 am
by GTOJim
D.H. wrote:At least this will prevent new charges from accruing while your dealing with this.
Her machine does not have a modem. I asked her insurance if the DME was billing for a modem, they didn't know. With very few exceptions the insurance requires some form of monitoring and the DME has been billing under that code.
A few days ago the DME sent a letter stating "Data Management and download does not have a capped rental with Blue Shield. As an office we have decided to cap the rental on this item as a courtesy to our patients"
Maybe we should send a thank you card, I'm being sarcastic. I would love to see them continue billing the insurance, what a load of BS.
Re: If you have a removable modem, remove it!
Posted: Mon Sep 19, 2016 11:22 am
by Guest
I wondered who he was directing this comment to?
D H wrote:At least this will prevent new charges from accruing while your dealing with this.
What was preventing new charges?