United healthcare supplies for cpap nightmare

Prettypistol · Post by **Prettypistol** » Fri Mar 02, 2018 2:08 pm

So we have United’s hmo choice, in network only through my husbands employer, and our Dme is 250 ‘per item’ than 100% of eligible expenses expendable goods at 100%. The issue is that we got my husbands cpap over a year ago (and paid out of pocket) Now we are trying to get supplies through apria .. ensue nightmare.

Since we already have the machine and have had it for well over a year, we are just trying to get our supplies (mask, filter, tubing etc) according to United’s policy. Apria confirmed we should be getting our supplies every 3-6mo at 100% coverage with no deductible and no co insurance (there verification team confirmed this) but NOW United seems to think they don’t have to pay a dime. Of course every time you talk to united you get different answers. Before we purchased supplies we confirmed through united and apria that we were covered at 100%. Well now comes the bill in the mail.....

The policy clearly states 250 copay per Dme item, HOWEVER expendables and supplies (mask, filter, tubing etc) covered at 100%. United is now telling us we need to pay 250 per item (filter 250, mask 250 and on and on) It’s like they can’t read their own policy.

Please help us sort this

ChicagoGranny · Post by **ChicagoGranny** » Fri Mar 02, 2018 2:16 pm

Prettypistol wrote: ↑
Fri Mar 02, 2018 2:08 pm
United’s hmo choice, in network only through my husbands employer

You should have an HMO rep. (This is not a DME employee.) Get in touch with the rep. If you don't have contact information, you husband should get it from his employer.

Good luck!

chunkyfrog · Post by **chunkyfrog** » Fri Mar 02, 2018 2:51 pm

My union lobbied to GET RID of UHC.
They were nothing but a nightmare.
Even BCBS were useless--buying my supplies online was cheaper

LSAT · Post by **LSAT** » Fri Mar 02, 2018 4:08 pm

Prettypistol wrote: ↑
Fri Mar 02, 2018 2:08 pm
So we have United’s hmo choice, in network only through my husbands employer, and our Dme is 250 ‘per item’ than 100% of eligible expenses expendable goods at 100%. The issue is that we got my husbands cpap over a year ago (and paid out of pocket) Now we are trying to get supplies through apria .. ensue nightmare.

Since we already have the machine and have had it for well over a year, we are just trying to get our supplies (mask, filter, tubing etc) according to United’s policy. Apria confirmed we should be getting our supplies every 3-6mo at 100% coverage with no deductible and no co insurance (there verification team confirmed this) but NOW United seems to think they don’t have to pay a dime. Of course every time you talk to united you get different answers. Before we purchased supplies we confirmed through united and apria that we were covered at 100%. Well now comes the bill in the mail.....

The policy clearly states 250 copay per Dme item, HOWEVER expendables and supplies (mask, filter, tubing etc) covered at 100%. United is now telling us we need to pay 250 per item (filter 250, mask 250 and on and on) It’s like they can’t read their own policy.

Please help us sort this

250 what??? We can't help you. It's between you and your insurance. I wouldn't believe ANYTHING Apria tells you. Most supplies are cheap and most don't need to be replaced often. Hoses last forever, filters are cheap. Most masks last a long time with periodic pillow/cushion replacement. I would avoid the headaches and buy on e-bay or amazon.

ChicagoGranny · Post by **ChicagoGranny** » Fri Mar 02, 2018 4:22 pm

LSAT wrote: ↑
Fri Mar 02, 2018 4:08 pm
I would avoid the headaches and buy on e-bay or amazon.

No. She should get what her premiums are paying for:

Apria confirmed we should be getting our supplies every 3-6mo at 100% coverage with no deductible and no co insurance (there verification team confirmed this)

I would give someone else a damn headache before I would give up a benefit I have paid for.

Cardsfan · Post by **Cardsfan** » Fri Mar 02, 2018 4:44 pm

Hard to believe there is a $250 copay for a filter. Something is wrong with this whole situation. I have UHC, not the HMO, and don't have issues like this. Ask UHC to send you the info in writing. Something is confused.

Prettypistol · Post by **Prettypistol** » Fri Mar 02, 2018 4:59 pm

ChicagoGranny wrote: ↑
Fri Mar 02, 2018 4:22 pm

LSAT wrote: ↑
Fri Mar 02, 2018 4:08 pm
I would avoid the headaches and buy on e-bay or amazon.
No. She should get what her premiums are paying for:

Apria confirmed we should be getting our supplies every 3-6mo at 100% coverage with no deductible and no co insurance (there verification team confirmed this)
I would give someone else a damn headache before I would give up a benefit I have paid for.

Exactally my point thank you

Prettypistol · Post by **Prettypistol** » Fri Mar 02, 2018 5:00 pm

Cardsfan wrote: ↑
Fri Mar 02, 2018 4:44 pm
Hard to believe there is a $250 copay for a filter. Something is wrong with this whole situation. I have UHC, not the HMO, and don't have issues like this. Ask UHC to send you the info in writing. Something is confused.

There response was you have a 250 copay per dme, they don’t seem to understand supplies fall under the expendable goods and supplies of a dme but are not an actual dme vs a supply. I have my policy in front of me, there quoting the same policy just interpreting it incorrectly,

Cardsfan · Post by **Cardsfan** » Fri Mar 02, 2018 5:14 pm

Does the policy actually state what is considered "supplies"? Do you have an EOB from a purchase and it shows you are responsible for $250 for 1 filter?

chunkyfrog · Post by **chunkyfrog** » Fri Mar 02, 2018 5:38 pm

The OP needs to contact their insurance, and first confirm that this supplier is in network.
Stuff changes with the new year.
Get the DME and your insurance on the phone in a CONFERENCE CALL.
Insist that things get settled before you leave.

Prettypistol · Post by **Prettypistol** » Fri Mar 02, 2018 11:01 pm

chunkyfrog wrote: ↑
Fri Mar 02, 2018 5:38 pm
The OP needs to contact their insurance, and first confirm that this supplier is in network.
Stuff changes with the new year.
Get the DME and your insurance on the phone in a CONFERENCE CALL.
Insist that things get settled before you leave.

Yes the dme is in network, confirmed before order and benefits verified.. the conference call seems like a good idea thanks

Prettypistol · Post by **Prettypistol** » Fri Mar 02, 2018 11:03 pm

Cardsfan wrote: ↑
Fri Mar 02, 2018 5:14 pm
Does the policy actually state what is considered "supplies"? Do you have an EOB from a purchase and it shows you are responsible for $250 for 1 filter?

The policy just says supply’s covered at 100%. There is no eob this is the first supply order. United has a separate document that list supplies individually with codes

DaMa · Post by **DaMa** » Fri Mar 02, 2018 11:48 pm

File a complaint with your state insurance board. In Michigan you can do it online at http://www.michigan.gov/difs/. You wouldn't believe how well this works. Also emails or letters to the CEO and to your Congressman. Call your local news -- most have a consumer advocate type who will work on consumer complaints. I worked for a large health insurance company and have seen all of these methods work.

Keep in mind, there are probably 1000s of people having the same problem you are.

Cardsfan · Post by **Cardsfan** » Sat Mar 03, 2018 6:47 am

So you don't have an EOB yet. You are just going by what someone at UHC read to you over the phone. Wait till you get the EOB and see what it says you are responsible for. That is all you will owe, no matter what the DME bills you for, you are only responsible for the contracted allowable amount. MY UHC EOB'S reads something like this: Ordered 1 filter, DME billed insurance $12, Insurance allows $2. You will get a bill for $2 from the DME After insurance has paid the DME. I think you are misunderstanding how this works. Or, in your case, you have 100% covered on "supplies" that is what your EOB will say. I hope. Really, just wait till you get an EOB and see what it says. Have you received any kind of bill yet, and from who?

Prettypistol · Post by **Prettypistol** » Sat Mar 03, 2018 1:01 pm

Cardsfan wrote: ↑
Sat Mar 03, 2018 6:47 am
So you don't have an EOB yet. You are just going by what someone at UHC read to you over the phone. Wait till you get the EOB and see what it says you are responsible for. That is all you will owe, no matter what the DME bills you for, you are only responsible for the contracted allowable amount. MY UHC EOB'S reads something like this: Ordered 1 filter, DME billed insurance $12, Insurance allows $2. You will get a bill for $2 from the DME After insurance has paid the DME. I think you are misunderstanding how this works. Or, in your case, you have 100% covered on "supplies" that is what your EOB will say. I hope. Really, just wait till you get an EOB and see what it says. Have you received any kind of bill yet, and from who?

I logged into uhc portal... the eob hasn’t been Mailed yet, but it’s on the site for me to see.

It says I’m being charged the contracted rate for the supplies. It says uhc is paying zero. Uhc themselves are the ones saying I have to pay 250 per item (nose filter etc) each time I order .

which in a convulated way means I will be charged the contracted rate (since it will never actually cost that much) each and every time I order a damn filter or mask. ..yet my policy states supplies and consumable goods are covered at 100 percent with no copay or deductible.

United healthcare supplies for cpap nightmare

United healthcare supplies for cpap nightmare

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