Aetna insurance - rental or purchase

Help please - I have been using a CPAP for 5 years that was purchased under Blue-Cross in Illinois - now we live in Florida and are coveredun AetnaQPOS - which is only slightly lower than a PPO. My husband was diagnosed with sleep apnea last summer and prescribed a BiPAP with humidifier. Our insurance has a "device" copay of $100.00 per device. The BiPap provided has been billing this as a "rental" at a high rate each month and then Aetna pays it short because they paid the $100 already....after many calls With Aetna and assurance that we do NOT have to pay this $100 every month - Aetna subsequently pays the provider...but it requires me to go thru many calls and different people each month and then a reviw of the billing before it gets paid. If I speak to the provider they say that is the only way they bill - as a rental. At this rate the provider is making out like bandit with collecting on insurance and/or from their customer because the machines get paid for quite fast.

Has anyone else run into this problem with their billing and do you know of a differnt way to code the billing. Our provider bills it to Aetna at $304 dollars a month for the machine and an additional $50 a month for the humidifier.
Thnaks for any advice.

Many insurance companies require a rent-to-own plan where you pay a monthly fee (and they pay some also) for roughly a year (more or less), at which time the machine is yours. They do this because the compliance rate of xPAP is somewhat low and they don't want to pay the whole bill up front.

I'm not sure why a DME would require that (unless they stand to make more $$ on that plan...) I paid $22/mo for 10 months, and BCBS paid around $130, I think. It is common for a regular CPAP to go for $1500 from a DME. BiPAPs are more, I'm sure.

In your case, it appears there is a significant disconnect between your DME and Aetna.

Snuzie wrote:Help please - I have been using a CPAP for 5 years that was purchased under Blue-Cross in Illinois - now we live in Florida and are coveredun AetnaQPOS - which is only slightly lower than a PPO. My husband was diagnosed with sleep apnea last summer and prescribed a BiPAP with humidifier. Our insurance has a "device" copay of $100.00 per device. The BiPap provided has been billing this as a "rental" at a high rate each month and then Aetna pays it short because they paid the $100 already....after many calls With Aetna and assurance that we do NOT have to pay this $100 every month - Aetna subsequently pays the provider...but it requires me to go thru many calls and different people each month and then a reviw of the billing before it gets paid. If I speak to the provider they say that is the only way they bill - as a rental. At this rate the provider is making out like bandit with collecting on insurance and/or from their customer because the machines get paid for quite fast.

Has anyone else run into this problem with their billing and do you know of a differnt way to code the billing. Our provider bills it to Aetna at $304 dollars a month for the machine and an additional $50 a month for the humidifier.
Thnaks for any advice.

shew have you checked the price on a humidifier? 50/month rediculous

LinkC wrote:Many insurance companies require a rent-to-own plan where you pay a monthly fee (and they pay some also) for roughly a year (more or less), at which time the machine is yours. They do this because the compliance rate of xPAP is somewhat low and they don't want to pay the whole bill up front.

I'm not sure why a DME would require that (unless they stand to make more $$ on that plan...) I paid $22/mo for 10 months, and BCBS paid around $130, I think. It is common for a regular CPAP to go for $1500 from a DME. BiPAPs are more, I'm sure.

In your case, it appears there is a significant disconnect between your DME and Aetna.

I paid $10.50 a month co-pay for 13 months. My insurance BC/BS FEHB paid $105.00 a month. That was for the Cpap and Humidifier.