Uh-Oh Somebody Goofed at the DME

This is not a "flame the DME" post. In fact, they've been nicer than most I read about on here. They told me in June I was due a new mask every six months, so I called today to get one ordered. Was informed that my coverage is one per year. Asked if that was calendar year or every 12 months, and they said I'd have to call my insurance. I did, and person on the line could find no record of when I was given a machine or mask. Said equipment is handled by case managers so I was transferred and CM could find no record either. She called the DME then called me back. Turns out not only had my DME never billed my monthly rentals since June, they had never even obtained authorization for me getting the equipment in the first place. I'd better be looking for a new DME, as I can see them falling into financial trouble if this is how they do business.

Just had a thought - sure hope insurance company policy wasn't changed from 6 months to 1 year effective on the 1st. If that were to be the case, the insurance company today could have been trying to stall me till I was past the deadline. But I doubt that as they told me to have my DME request another mask and tell why and they would review it and see if it goes thru. Maybe they're filling requests that fall near the deadline.

Gosh, I don't think I used to be this suspicious. Oh well.

KTeague, I received my CPAP equipment on 09 Oct 2006. My local DME (the sheister one) didn't submit a claim to Medicare until April of 2007!!!!

I think that the DME has more than a year to submit the claim. Our hosts here should know .

Anonymous wrote:I think that the DME has more than a year to submit the claim. Our hosts here should know .

I think THAT would be absurd! (not to mention extremely horrible accounting practices)
Insurance fiscal years usually roll over on January 1 or July 1 and insurance providers can change, too.
If that's the way the DMEs are operating, they deserve to lose their asses (financially speaking, of course).

Den

If they want to bill in lump sums and that works for them, oh well. But if prior authorization is required and that didn't happen, those bills could be denied. The loss would be less if discovered sooner.

Just as long as they don't try to come after me for payment if that happens.