I just can't believe these insurance companies!

Lyn · Post by **Lyn** » Tue Sep 13, 2005 9:14 pm

When I went to get my cpap equipment the end of July, the DME supplier already had it all set up. ResMed S7 Lightweight, hose, O2 hose connector & Activa mask & headgear. These items would total approx $414.00 thru cpap.com. I had been told by the ins co that the equipment would be a rental "for as long as I needed it".

I got the EOB this past Saturday. The supplier billed the ins co $1880.00 for purchase. The ins co approved $1420.78, of which, I would have to pay about $284.00.

I had previously called the ins co twice & told them that this equipment was fine for rental, but that I travel some & wanted to look at purchasing something smaller. I was thinking that I would just go thru cpap.com & submit the bill as an out of network supplier purchase.

Guess what! If I want to go thru an out of network provider, I have to first cover ANOTHER $1000.00 deductible.

INSURANCE COMPANIES S_ _ K ! (Stink?)

Lyn

rock and roll · Post by **rock and roll** » Tue Sep 13, 2005 9:41 pm

They do indeed as do the DME's that rob them and us. Do what I did, tell the DME that you know what it can be bought for, you know what they got from the insurance company and if they expect to collect ANYTHING from you, then come pick it up. They won't, do the math, they still make a killing and don't want to give the money back. They will argue but stand your ground.

NOzsnAZ · Post by **NOzsnAZ** » Tue Sep 13, 2005 9:49 pm

Why doesn't the insurance company do something about this to save themselves the $$. I'm pretty sure that is one of their primary goals -to negotiate better prices for their services.

Is the CPAP market SO small that they are busy chasing bigger dollars elsewhere?

You'd think a little investment in websurfing for comparable prices would be all it would take for them to squeeze the DMEs themselves...

rock and roll · Post by **rock and roll** » Tue Sep 13, 2005 9:58 pm

You would think. I called mine, several times, and they think that they are getting a sewrvice because the DME will teach us how to do it and take care of us and....willing nto rent to own. They just don't care.

Lyn · Post by **Lyn** » Tue Sep 13, 2005 10:03 pm

It just makes no sense. They want me to shell out another $1000 if I go to an out of network supplier when it would save them $1000 if I did!

Lyn · Post by **Lyn** » Tue Sep 13, 2005 10:06 pm

It's like they want to penalize a person for trying to save them money.

Fatigue Fighter · Post by **Fatigue Fighter** » Wed Sep 14, 2005 2:52 pm

Ah yes....I have to rent too. The way I look at it is that I can also decide to change machines whenever I want.

That aside, I bet the insurance companies and DME folks have negotiated rate contracts for their services and supplies that tie the insurance companies hands. Probably a non-competition type of clause in their contracts or some other arrangement that makes it expensive for the patient know matter what (like your having to pay a huge deductible first). Most DMEs, I suspect, sell services and equipment that are more than CPAP supplies and the rates for these services/supplies are bound with other types of medical equipment. Third party players like DME's are very expensive because they want their Overhead expenses covered. That's my guess. It's probably why a lot of folks just pay out of pocket and buy equipment on-line.

FF

morphy · Post by **morphy** » Wed Sep 14, 2005 3:13 pm

I have CIGNA

They paid $1,046 for what I could have paid $559 at cpap.com.
I complained to them that they wasted about $500 of my limited (there is a max overall benefit) coverage which I may need in the future.
CIGNA said 'tough'. "Can't help you'. !!!!!

I have a friend who is fond of saying "when something doesn't make sense, look to see who's making dollars and cents."

It'd surprising how often he is right.

Flower51 · Post by **Flower51** » Wed Sep 14, 2005 9:35 pm

Sorry for your frustration Lyn....something most on this board are familiar with, those of us who have insurance anyway. I'm beginning to get a run around also...suddenly the money amount I was told it would cost every month (over the phone, nothing on paper of course) has more than doubled. Still not a terrible amount of money broken down month by month but yowza...who else can do business this way? Terry

Mask