Switching Insurance Co's While Renting???

I'm currently renting my cpap through my wife's health insurance from her job. In December, she's going to be switching insurance companies.
Does anyone know if the new company would continue my rental agreement with the DME, or would I have to start all over again from scratch?
If I have to start over, what happens to the cpap I have now? CAN, I turn it in, since it's a rental, or do I have to continue renting it or buy it outright?

December is my 6 month point on cpap, the machine will be half paid for by then. It would really suck if I have to start all over again, especially since I won't have reached my annual deductable with the new insurance, and will have to lay out most of the over inflated price the DME charges out of pocket.

I tried to get some info from the new insurance company, but since I'm not a member yet, they won't talk to me! I also TRIED to talk to my DME about me buying the machine out right. The person I spoke with was NOT the sharpest knife in the draw! She quoted me a price that was MORE than what ALL my equipment cost. I told her I didn't need a mask, hose, or humidifer, since I already OWN those. She said it didn't matter, that was their price, period!

If anyone has gone through switching insurance in the middle of renting, I'd appreciate any advice you could give me.

Each and every insurance company can have widely varying policies. Have you checked with your current insurance company to see if you can convert your rental to purchase before the change in insurance? The annual deductible being met now may be a moot point in January. When does the annual deductible start over? Most seem to start new in January.

Years ago when people had plain old group insurance through employers and the insurance was changed the new company would allow someone to "have met" the deductible with them if it was met with the old plan but today with all the variation in offerings from PPO, HMO, etc they have so many ins and outs between policies that there is no blanket answer. They can pretty much do what the please within the confines of the fine print of the policies.

If your current DME is a in network provider for the new company they might allow for continuation but I bet the new deductible will apply in January for sure. If they aren't a providing member then it likely would be considered out of network and be subject to whatever limitations the new policy has in that area.

If there is someone in your wife's company that is handling this changeover they might be the person to help figure out what the new policy will cover. They might have an agent who can help answer questions. The new insurance company can't give you any information because the new policy has yet to really go into force. They won't go out on a limb at all just in case something changes or they are wrong. An insurance agent or broker might be able to find out for you.

What will be the deductible on the new insurance? If it starts over in January, do the math, might be cheaper to buy online.. if you can't get your current DME and insurance company to come to a workable solution.

Yikes! I'm guessing you'll be starting over. The DME would love that as they stand to keep all the payments thus far. And it sounds like your new ins co isn't interested in saving money (they will lose more than you will by not continuing the current deal!)

IF you are going to start over, I'd insist on a new machine. It's a small consolation, but only fair since you're starting from square one.

I assume changing companies mid-stream is really necessary?

There is no need to "start over". The DME will already have half their money by then. I would definitely try to get the current ins co to convert to a purchase before the end of the year.

The deductible is another issue, though. If you will be having a high deductible, and the "old" ins co won't convert to a purchase, this is what I would do... come December, I would try to cut a deal with the DME to pay it off. If they know you are paying out of pocket, cash or check right now, they just may work with you, especially if it is not a national chain company. After all, their contract with your ins co is now out the window as you no longer have the coverage. If you go this route, I wouldn't even tell them about any new coverage. Just tell them you no longer have your current coverage.

Good luck. Remember, everything is negotiable!

Your DME has made a rent to own agreement with you, not your insurance. So, your new insurance may want the DME to provide all the documentation to prove medical necessity and compliance but the amount paid by your first insurance should not be a factor. The deductible and co-pays will most likely be a factor. Therefore, as you are 6 months into the rental you should be able to prove compliance and benefit with your current insurance and ask them to pay the balance prior to coverage ending. The tricky part is getting your DME to send a correct bill. As it is going to be balance billed for purchase the rental modifier needs to be changed from "RR" to a purchase modifier of "NU". This is a very common error. Also, if your DME has a savvy biller they will want to do this as it is a lot less expensive to send one bill versus 6 more.

Also, if your DME has a savvy biller

Isn't that a redundancy? lol Isn't that what the DME is all about.

Hey, this local DME has already recouped their actual cost of the device from those 6 monthly rental payments. They benefit if you elect to continue the payments yourself, they benefit if you tell them to shove the device where the sun don't shine. Either they get the full agreed upon 12 monthly payments for the device or they get one whose cost to them has been paid AND a lightly used device to use as a loaner rental while someone else's defective device is returned to the manufacturer for replacement or repair. Either way, its a win-win situation for them.

Slinky wrote:Either they get the full agreed upon 12 monthly payments for the device or they get one whose cost to them has been paid AND a lightly used device to use as a loaner rental while someone else's defective device is returned to the manufacturer for replacement or repair. Either way, its a win-win situation for them.

OR, if they require a new contract under the new insurance provider...they get BOTH a "free" lightly used loaner machine AND a new profit-making contract. It's "win-squared"!

Slinky wrote:Hey, this local DME has already recouped their actual cost of the device from those 6 monthly rental payments. They benefit if you elect to continue the payments yourself, they benefit if you tell them to shove the device where the sun don't shine. Either they get the full agreed upon 12 monthly payments for the device or they get one whose cost to them has been paid AND a lightly used device to use as a loaner rental while someone else's defective device is returned to the manufacturer for replacement or repair. Either way, its a win-win situation for them.

You got that right! Not only did they charge an arm and a leg for the mask,hose, & humidifier, they're charging my insurance $400 a month for the cpap rental!
Let me tell ya', ain't NO WAY, I'd be paying my DME $400 for 6 months to buy my machine outright!

That $400 is more likely your DME's "pipe dream price" and your insurance company is paying considerably less than that.

I had to go through this too at 6 months in and crossed my fingers it would be covered. I had a cheap of benefit/high price per week insurance policy throuth United healthcare. I dropped this plan 6 months in and switched to my wife's plan who was also with United healthcare but a different plan and job with many benefits and much lower costs because it is for a hospital staff.

Anyway, luckily they picked up the remainder of the 6 months on the machine rental and now it is paid off.They also paid for my wife's rental the next month when she was diagnosed so they were paying two machines each month.

I had a backup plan that i bought a used machine at cpapauction so i had something in case they wanted me to start over or a crazy price per payoff.

I hope it all works out for you as well

Once again - the DME company doesn't determine either the submitted amount or the billed amount.

Those are set by the insurance company. The DME provider has no control over it.

It's not a pipe dream price, it's not something that the DME company has set out to try to rip someone off with.

Just a point of clarification is all.

To reiterate what's been said before......
Try to get your current insurance provider to payout/buyout the remainder of your balance before the end of the year and before your new one takes over. If not, you're also going to (probably) be hit with another deductible from the new insurance provider (it's going to be another new fiscal year, too).....and who knows what other charges if you would have to change DMEs.

Den

mattman wrote:Once again - the DME company doesn't determine either the submitted amount or the billed amount.

Those are set by the insurance company. The DME provider has no control over it.

It's not a pipe dream price, it's not something that the DME company has set out to try to rip someone off with.

Just a point of clarification is all.

Why is it so hard to believe that insurance would say you have to bill way too much before we will consider paying you? More like they set a max limit they will accept as reasonable. Really!

When I was diagnosed in August of 2007, I was on my hubby's insurance. At the time, I had my deductible met and had decent coverage. I was told that my machine would be on a rental contract of a year. The mask, hose, etc. were purchased so not a problem In December I learned we were no longer going to have the same insurance carrier as his employer had changed companies with his premium covered but mine would be out of pocket and more expensive than where I work. I called the insurance company in December and explained my dilema and they told me not to worry. The would convert the machine to a purchase if the DME would bill it as a purchase. A note was made in the policy and my "rental" became a purchase without a hitch. I ended up only paying $15.00 for my M series APAP (my total cost). The DME billed it as a purchase insurance company paid, I received a paid in full statement since I had already paid the $15.00 copay.

Talk to your present insurance company, be nice, remain calm, and see if you can do the same. This was a big weight lifted from my shoulders as when I switched insurance companies to my employer the coverage pretty much stinks. High deductible, exclusions, etc.