General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Kiralynx
- Posts: 2415
- Joined: Wed Oct 08, 2008 5:42 am
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by Kiralynx » Mon Dec 21, 2009 9:19 pm
leejgbt wrote:I believe your insurance might be violating an insurance regulation. You need to call your insurance commissioner as this type of "captive referral" system is prohibited in Montana (so I suspect elsewhere also). <snip> Someone at that insurance is misinterpreting their own rules I think.
Well, I rather thought they were misinterpreting it.... thank you for the suggestion of contacting the insurance commissioner.
leejgbt wrote:As for Apria asking you to sign something making you responsible for the entire billed amount you were right to decline. Also, Apria does not have the right to tell you which mask you can order. If you have an RX for two different masks they have to honor this RX. The replenishment rules for payment are the only guidelines they are held to, not the type of mask.
Apria did not have the code for the mask I wanted to order in their computer system and the people I was talking to were too blinking LAZY to look it up. Considering it took FOUR MINUTES for Aeiomed to respond with the correct code when I contacted them, this says something about their attitude. This is not the first time they've pulled this -- they did not have the correct code for the Comfortlite 2 Direct Seals which I favor, and ran me around the ring over those.
-- Kiralynx
Beastie, 2008-10-28. NEW Beastie, PRS1 960, 2014-05-14. NEWER Beastie, Dream Station ASV, 2017-10-17. PadaCheek Hosecover. Homemade Brandy Keg Chin Support. TapPap Mask.
Min PS = 4, Max PS = 8
Epap Range = 6 - 7.5
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Kiralynx
- Posts: 2415
- Joined: Wed Oct 08, 2008 5:42 am
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by Kiralynx » Mon Dec 21, 2009 9:23 pm
Gerryk wrote:Kiralynx who is your insurance company? I do believe most states have a department that covers insurance and regulations. I would look it up in your state and give them a call. Explain what has happened and even fax or email a copy of the response from your insurance company. I do not believe what they say is true or legal. I wouldn't argue with the insurance company, rather go find out if what they have done is legal in your state or if the state will get involved. I would bet all you need is a letter from the state that what they are doing is illegal and they will change their mind real quick.
All it takes is a phone call.
Gerry,
My insurance is Aetna -- I believe we have an EPO (I'm too tired, after working all day behind a cash register during Christmas Insanity Season to go get my wallet and look at my member card.)
I will see what I can find tomorrow with a bit of Googling around. Of course, if you, or anyone else happens to know something for Louisiana, that would be really helpful.
-- Kiralynx
Beastie, 2008-10-28. NEW Beastie, PRS1 960, 2014-05-14. NEWER Beastie, Dream Station ASV, 2017-10-17. PadaCheek Hosecover. Homemade Brandy Keg Chin Support. TapPap Mask.
Min PS = 4, Max PS = 8
Epap Range = 6 - 7.5
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Gerryk
- Posts: 1565
- Joined: Thu Jan 01, 2009 11:18 am
- Location: Chicago suburbs
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by Gerryk » Mon Dec 21, 2009 10:34 pm
Best of luck to you, let us know what you find out. Hopefully you will be resting well again soon.
Gerry
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
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by rested gal » Tue Dec 22, 2009 12:14 am
Kiralynx wrote:rested gal wrote:Yup. There's method in their madness.
Yes, so the question is -- what to reply to THIS bit of madness.
I've not ever had to deal with insurance (don't have any) or with DMEs (I buy out of pocket online) on CPAP matters. What Gerry said sounds like the best course of action to me. Similar to what leejgbt mentioned.
Gerryk wrote:Kiralynx who is your insurance company? I do believe most states have a department that covers insurance and regulations. I would look it up in your state and give them a call. Explain what has happened and even fax or email a copy of the response from your insurance company. I do not believe what they say is true or legal. I wouldn't argue with the insurance company, rather go find out if what they have done is legal in your state or if the state will get involved. I would bet all you need is a letter from the state that what they are doing is illegal and they will change their mind real quick.
All it takes is a phone call.
Gerry
Good idea, Kira --
Kiralynx wrote:I will see what I can find tomorrow with a bit of Googling around.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
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Kiralynx
- Posts: 2415
- Joined: Wed Oct 08, 2008 5:42 am
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by Kiralynx » Tue Dec 22, 2009 7:45 am
Well, this looks like a place to start....
http://www.ldi.state.la.us/Health/index.htm-- Kiralynx
Beastie, 2008-10-28. NEW Beastie, PRS1 960, 2014-05-14. NEWER Beastie, Dream Station ASV, 2017-10-17. PadaCheek Hosecover. Homemade Brandy Keg Chin Support. TapPap Mask.
Min PS = 4, Max PS = 8
Epap Range = 6 - 7.5
