Don't Pay that Upcharge!!!

I've added a new page to my blog http://maskarrayed.wordpress.com/dont-p ... -upcharge/.

I keep reading about people who decide that they want an S9 or Respironics auto machine and they are told by the DME that they can have exactly what they want if they pay an "upcharge"--an amount over and above what your insurance company allows for that particular HCPC code item. This is a charge in addition to your required deductibles and co-payments.

In very rare instances an upcharge may be permitted, but you should be aware that upcharging is NEVER permitted of traditional (part A/B) Medicare recipients and the process, also known as "balance billing" is ILLEGAL to some degree in 47 states. Furthermore, balance billing is prohibited by most insurance contracts, and asking you for this additional money may even constitute FRAUD. Too many people fall into this trap and may pay hundreds of dollars more than the DME is permitted to charge them, thinking that's required to get a desired machine or mask. In general, it is NOT.

On that blog page I have some steps to take if your DME is trying practice balance billing on YOU. I think it's important to report these DME's to state regulatory agencies if balance billing is not permitted in your state. Otherwise, the DME's will continue to do this to people who are not as smart as you are, and they should not be permitted to get away with it.

NOTE, however, that if your insurer is an HMO or otherwise requires you to use only a preferred provider, you may have to pay the entire cost out of pocket and the insurer's allowable charge may not apply. And, of course, you may have to pay more to an out of network provider if your insurer allows you to go outside the network.

Thank you for always giving us excellent factual information about insurance issues. You're a treasure!

VERY good point about keeping DMEs honest.

Also, as discussed in another post both Respironics and Resmed (and maybe others) give the DME a replacement mask on any mask rejected in under 30 days. Some DMEs (I've seen it at online DMEs) offer to sell "mask insurance" to replace a mask within 30 days so they are charging for something they get for free.

They should be challenged on this. Don't buy a mask from a DME that doesn't offer to replace it free in the first 30 days.

VERY good point about keeping DMEs honest.

Also, as discussed in another post both Respironics and Resmed (and maybe others) give the DME a replacement mask on any mask rejected in under 30 days. Some DMEs (I've seen it at online DMEs) offer to sell "mask insurance" to replace a mask within 30 days so they are charging for something they get for free.

They should be challenged on this. Don't buy a mask from a DME that doesn't offer to replace it free in the first 30 days.

Also, as discussed in another post both Respironics and Resmed (and maybe others) give the DME a replacement mask on any mask rejected in under 30 days. Some DMEs (I've seen it at online DMEs) offer to sell "mask insurance" to replace a mask within 30 days so they are charging for something they get for free.

Some online suppliers charge the mask insurance to cover the cost of postage and paperwork back and forth. That makes sense, particularly since they are charging so much less than brick and mortar DME's in the first place, and because you can't try the mask on before buying, the frequency of returns is going to be higher. Online suppliers don't have that extra "cushion" of profit to cover the shipping costs, time and paperwork for shipping new masks back to you and returning the used mask to the manufacturer.

So I don't disagree with buying "mask insurance" from an online supplier, but a brick and mortar store has no business charging that fee.