Milking it? Understatement of the year.

Looking back over the insurance claims, I find that for my 2-week follow-up after getting my machine, they charged for an office visit. Makes sense. Later they also charged for a compliance check by a doctor on that same date. Uh, maybe, but I certainly didn't speak to one. Never have.

But here's where I really start questioning things. a month later I popped in to get a replacement nasal pillow. They charged it - AND a $140 office visit. The only person I talked to was the SALES dude.

Another month, and I picked up 2 more, plus replacement filters - and I asked a question about the billings. Seems they charged an extra thousand for the first night of my sleep study. I was told they'd fix it - again by the sales guy, the only one I talked to. The insurance claims for that day? Nasal pillows, filters - and a $140 office visit. No change on that first night's charge, by the way.

Am I wrong to think that's out of line? An office visit just to get supplies, particularly when I don't have any professional services performed?

You should be spelling this out to your insurance company. Why are you obtaining your supplies from your doctor's office. Check with your insurance and find a local DME.....DUMP THAT DOCTOR.

Sounds very familiar to my post earlier this evening... viewtopic/t76813/Can-a-DME-bill-under-M ... 94660.html

That's insurance FRAUD. An office visit does not occur unless a professional actually sees/talks/examines you. And have to have a note in your chart written by the professional. Otherwise, it is totally fraud. Tell your insurance company that your sleep doc is billing you for office visits when all you do is get supplies. They'll be very interested in that fact and could even conduct an audit of his medical charts. For every office visit he billed without making any kind of note in your medical chart will have to be paid back. And don't let then threaten you into paying any portion of those. That just plain FRAUD.

I assumed I was going to see thoughts on the secret service problems in Columbia when I saw the thread title.

No, this isn't the doctor - this is the sleep clinic! Where I have never spoken with anybody trained above the level of the tech who did my sleep study. The lady who did the followup visit about my system & looked over my charts was 2 weeks into the job. Referred to my leak rate as "under 24% - good!"

The followup, the system pickup/intro, and 2 nights of sleep study are the total actual technical visits I've made there, plus 2 visits for supplies. Both supplies pickups, they also charged as an "office visit", though I only talked to the sales guy - a day worker that books night-time studies.

EDIT Mark, LOVE your "full face" mask! what make & model number?

So - have you fought it yet? I called my insurance company and disputed my phoney "CPAP Management" charge last friday, and was told they would get with the DME and let me know the outcome by 4/17 (yesterday). I called the insurance company back yesterday evening and they had not done it yet. I gues I'm calling the DME today and we're going to have a little chat. I'm getting an order for a new flow generator tomorrow, and need to know where I'm going to go to get it... This DME was pretty easy to deal with 4.5 years ago when I started, right around the corner from where I live, and most of the time now supplies S9 autos (which is what I want) so I was kind of hoping to get it from them. If I change DME's none are officed locally, and not sure what they supply. So, my goal is to get this phoney charge dropped off my bill by threatening to "fire" them, get the new machine, and not visit again without discussing the BS charges up front. The only thing they've ever discussed with me about my care was "what supplies do you need now?" But, I'm ok bwith that if they keep shipping them to me at zero out of pocket cost (in other words no management charges). I don't need thier input on how my numbers look!

ekubaskie wrote:No, this isn't the doctor - this is the sleep clinic!

Any clinic that "sells supplies" has NO interest in you, only in sales.

That should be a Red Flag to anyone looking for a DME - is the DME part of (or housed in) the same business or building. Ask those questions when choosing, you won't be disappointed.