Overcharging the Ins. Co.

You won't believe this one. Apria charged my insurance company(Cigna) $728 for my Hybrid Mask and they paid $515 on the claim!!!!!!!!!! I called to see if this was a mistake but it seems that is the contracted reimbursement for that mask. All the other equipment I have gotten in the past was pretty much in line with CPAP. com but I don't understand why the high charge and payout on this mask. They had to order it but still! Cigna even got snippy with me when I asked who I could speak to about this outrage. She said another dept does that and they don't speak to the public about how much allowable charges are etc. Then she said that CPAP machines have different codes depending on what one you get so I guess she doesn't know what she is talking about either. Basically the DME's are ripping off the insurance companies and they don't care, I guess. No wonder we have to pay such high premiums. I tried to do something but it seems nothing can be done. I can't purchase out of network, must go through and approved DME so I can't order from CPAP.com. I will check out Lincare, they are in network for me and I want to get rid of Apria, they lie too much and don't know what they are talking about half the time. I have gotten such crummy care through them, everything I have learned about my cpap and masks etc. have come from the good people on this forum. Does anyone have any dealings with Lincare and if so how do you like them. Thanks.

Wow yeah that is seriously messed up. Do you have to pay a co-pay on that? Seems like if so it'd almost be cheaper to just buy it online. I sometimes wonder if these super high approved rates are one of a couple things...to keep you from using the benefit because the co pay is so high, or some sort of collusion between insurer and manufacturer.

I'd check the HCPCS code on your EOB. Sure sounds like Apria mis-coded and you just got some snit at the insurance company who ought to lose her job!

ya know, i called my insurance (aetna) to make sure the charges were legit, and they got crappy with me too.
i told her all i was doing was making sure the DME wasnt billing for anything that i didnt recieve, she didnt seem to care, told me it looked acurate.
HOW THE HELL WOULD SHE KNOW, he could have billed for 5 masks, when I got 1. I never even signed anything saying I recieved anything.
Here we are trying to make sure charges are in inline, accurate, etc. and they dont care. No wonder the health care system is screwed up.

I was with Lincare. They are no better. They "forgot" to stop charging for the rental on my cpap after six months like they were supposed to. I could never reconcile the bills they sent me with the EOB I got from my insurance. When they charged me for the cpap they listed each accessory (Hose, gasket, filter etc.)separately and then charged for each one, even though they came with the unit. When I finally started to decipher their bills, I figured out that my copay for some items was just pennies less than what I would pay full price for the same item online. If I waited to pay my portion until after the insurance paid, I would get a collection letter from them. To their credit, the staff in the office was very nice. Since my cpap has been paid for, I haven't done business with them and never will again. I am now a shameless supporter of CPAP.com, the people who host this site. They ship fast and there are no surprises. My insurance doesn't re-imburse as much (50% as opposed to 80%) but their prices are cheap enough to offset the difference. I hope you find a good company to deal with.

They don't "CARE" because they're passing the costs along to YOU.

Den

I could tell you some stories about Lincare, but I digress, just let me say that after hasseling with them for several years and after they got a new manager who told me I couldn't have the mask I wanted because it wasn't in inventory....I completely severed any further connection and started buying every thing I need, 'WHEN' I needed it, from CPAP.com,
Thank you CPAP.COM

I had Medicare and a supplemental Insurance that picked up the balance after a yearly deductible, but I feel that being able to order what I need, at a fair price, out of my pocket, is the best switch I ever made. Just the absence of stress from getting shed of Lincare is worth it.

The person I delt with at Medicare even called me on the phone and advised me how to drop my ties to Lincare.She said they knew the pricing was out of sight, but couldn't change it at her level....

BTW, at that time, in my area, Lincare was the only local DME, they felt they had a lock on us...

No I don't have any copays. I just think something should be done to stop this fraud by Apria and the other DME's because in the end it drives up the cost of health insurance. I wonder if there are any good DME's out there. I'm going to investigate Lincare and a few others that are on my list of providers in network. I am sick of dealing with Apria and their lies and shoddy care. Thanks again everyone for the help you have given me. I wouldn't know anything and would be in a world of trouble without all of you.

A DME can bill all the pieces of the mask separately. With the hybrid that is makes it a big profit item as there is headgear, several mouth covers (cushions), several sets of nasal pillows, and don't forget the mask itself.

Check the billing with insurance (if they will talk to you) and get the itemized scoop. I bet you got 3 cushions and 3 sets of nasal pillows billed all as part of this.

BTW: Lincare is about as crooked at least in my area.

This whole process of getting machines and insurance is VERY confusing and frustrating...and it seems some dont investigate enough with there insurance companies, including myself!! I left my sleep Dr.'s office today with my first machine, they carry almost all of them in stock along with the masks. I asked the tech who was fitting me with the mask and showing me the features of my M Series w/ humid how much the Dr's office was going to bill my insurance for the machine? The reason I asked is because my insurance allows up to $2,000 a year for med equipment, I pay 10% of any equip. If I exceed $2,000 in a calender year I pay EVERYTHING out of pocket. So she told me im not sure, I think the machine is or may be around $1,500??? Plus mask??? My copay is only $150.00 out of pocket for machine but that also means I dont have much left to bill before its all out of pocket....Thoughts? Normal??

Mike081376
I suspect they gave you a barebones machine too?

slapmeawake wrote:.......... I just think something should be done to stop this fraud by Apria and the other DME's because in the end it drives up the cost of health insurance. .......... I am sick of dealing with Apria and their lies and shoddy care. ........

If I had the time I would go to our State Attorney General about Apria. I, like you, also have a horrible story about what they are billing the insurance company. And the insurance company is paying.

There are not enough prisons to hold all the white-collar criminals and Congressmen that need to be there.

Many major insurance carriers have the option for online member services. My carrier's online membership area has a claims listing option. I can look to see the claims submitted, charges submitted, services being billed for, clinical diagnosis for services provided my copayment and coinsurance. I can print information and use for flex spending account reimbursement as well. At the moment I'm chuckling at the DME I got my machine through. I actually got my machine 12-08; They billed the insurance for almost $600 initial charge, then billed a monthly charge for 10 preceeding months......the $600 charge plus some of the monthly charges are over a year old by date and have been denied by insurance with a notation insurance saved X $$$ and I owe nothing. The correct billing should have started for services in Dec 08 and a monthly charge for the following 10 months in 2009. They billed for services before I even had my sleep study. I chuckle as they either have to fess up they billed before services provided *greedy* or take the loss for filing claims over a year old, and eat it!!!! The DME I used No Showed the set up appt......poorly handled my compliant for a long drive in very cold weather/bad roads/sitting in my car trying to stay warm for over an hour waiting for the unhappy oncall person.......and now they may have screwed themselves or at least caused themselves extra work to correct the billing. Oh well, sometimes it's nice to see the squirming reversed!!!!