A $$ question

I will indeed keep people posted on the outcome. For now, I have begun to get sucked into a Bermuda Triangle of confusion, where the 3 points on the triangle are the DME local office, the DME's billing office, and the insurance company. Each is telling me the situation is not their problem and that I need to call one of the other two.

In the meantime, I went and tallied the amount that the DME has already billed the insurance company for the S8 Escape machine I've got. It's ten months' worth of rental bills at just over $200 per month, of which I paid just over $20 per month in coinsurance. So I'd already paid $200 in rent on the machine by July, when the insurance company unilaterally decided to buy the machine for me, at an additional cost to me of $600 (because it was the beginning of the deductible year).

This is so not right on so many levels ... but pinning the problem on either the DME or the insurance company is going to be quite a task. Grrrrr.

(By the way, I know the machine is a basic one that doesn't allow me to monitor any sort of sophisticated data on usage and effectiveness -- but that's actually OK with me. If I had all that information, I'd just obsess about it, which is the last thing I need. The machine is very light-weight and quiet, and since I travel a lot and am a light sleeper, those are the two most important criteria for me.)

Thanks for the feedback/suggestions, everyone!

--Eric

OK, folks ... situation basically resolved. A kind person at my DME agreed to do a conference call with me and their billing department, and it turns out that more than 300 of the 600 they were asking for was the result of an insurance company error -- not giving me credit for all the rent I've paid, and misallocating some expenses to my deductible. So I am looking at paying 270 for the machine rather than 600. I can live with that.

Thanks for the support and suggestions.

--Eric

elmunc wrote:Hi all,

I could use a little advice about the cost of a CPAP machine and interaction with insurance. Here's the deal. I got my S8 Escape a year ago through Lincare. (This machine is available for $720 through online sellers.) I paid rent on the machine monthly, with a portion covered by my insurance. Then in July -- just in time for the annual reset of my deductible -- the health insurance company decided it was time to stop renting the machine, so they bought it for me, as it were. The result: I now owe $600 for the machine -- my portion of the absurd charge of like $2700 or some such thing that Lincare charges the insurance company. The number is that high because I hadn't yet met my deductible.

This is all feeling like a big scam. Am I wrong to think of it that way? I've ended up paying more for the machine out of pocket (the $600 plus the monthly rent for 9 months) than I would have paid if I could have just bought the machine outright at the start.

If anyone sees anything fishy in this, or has any advice, I'd certainly appreciate it!

--Eric

Well this is what you need to know.

Once you get a dx of OSA the doctor will write a prescription for a machine with a pressure setting, the mask is understood. How your DME is chosen may or may not be up to you depending on your insurance. The DME will meet with you and set up up with a machine and a mask. Now some insurances will require the machine be rented for a period of time before they purchase it because the failure rate to comply with CPAP therapy is like 60%. The DME will bill your insurance by using one billing code no matter which machine and mask they hand you. So, if they get you to accept the cheapest machine and mask while being in compliance with the doctor's orders, the DME will pocket the difference which means more money for them. So, you have paid for the rent on your machine then the DME is turning around and selling you your rental CPAP machine at the billing code price.

I had to learn the hard way too. But, I am a very curious person and I was able to fire my DME after visiting this website and getting the lowdown on the workings of the business of sleep medicine.

Things that you should expect as an OSA patient.

One, make sure you have a certified sleep medicine doctor. GP's don't cut the mustard.
I personally think the better sleep doctors are also pulmonologists since they are the medical experts on breathing.
The doctor should write you a prescription for a data capable machine and accept nothing less than data capable.
If you request it, by law the doctor must write you a prescription to give to your person for keeping.
Get a mask that fits. Most give up on CPAP because of a poor mask fit.

Two, make sure you use a certified sleep center when getting a sleep study.

Three, request a list of which DME's are accepted by your insurance. Competition is your best friend.

Four, follow you own progress if you can by reading your data. Having a stake in your own health goes a long way to successful treatment.

If you have not signed a bill of sale on your machine, you don't have to accept the terms given to you by that DME. Tell them you wish to shop around. If they go the "I gonna tell the doctor" by having you sign a noncompliance paper, don't sign anything, just tell them you are going to seek therapy with a different provider just not them.

Good luck

I don't trust Lincare as far as I can throw them.