ughwhatname wrote:Something doesn't smell right about that... The DME is charging the insurance company the "balance biling" they tried to get you to pay by charging under an additional code? What would concern me is working with someone with questionable ethics, and if the insurance company doesn't pay the extra charge, do you get the pleasure of that?
Yes, in actuality, you're correct, and I told the DME as much. However, I attempted to get a machine through 5 different DMEs, and every last one of them has little regard for the balance billing laws. All of them were insistent that they were either going to charge me or charge the insurance company. None of them have any concern over this.
The reason I settled on this particular DME is that 1) a good friend of mine who has been on CPAP therapy for years uses this DME and he has always felt that their service is awesome. 2) I can vouch myself that the person who helped me get a mask fitted and issued the equipment was very nice, very knowledgeable, and is committed to helping me with whatever I need. 3) When I voiced the concerns over the billing and the billing practices, she called the owner of the DME, who met with me personally, and she explained from a business perspective why and how her billing methods are done.
Though I still don't agree with what they're doing in their billing process and yes, they're essentially overcharging the insurance company, at this point I feel like I'd never get a machine if I otherwise don't play along. Yes, I'm a bit of a snob for wanting an S9 Autoset when I could probably be successfully treated with a non-auto machine, but let's face it, the autos have a lot of advantages:
1) By reducing pressure when able, the system is more comfortable for the patient, and increases compliance.
2) Since I will have the machine for 5+ years before I get a replacement, an auto means I can be just as successfully treated on year 5 as I am now, even if my pressure requirements change due to weight gain/loss or other changing factors over time.
3) An adaptive machine that can do that is likely to actually save the insurance company money in the long run because I won't need another sleep study to determine a new pressure.
To top it off, let's not forget that the DME is not the only one who is trying to take advantage of a fundamentally flawed system. The insurance companies have culpability here as well. If you point out to the insurance company that the extra $300 for an auto machine now could save them $3000 on a future sleep study that the patient may not have to have, they will tell you that they don't care. Why? Because in all likelihood, you will have a different insurance company 5 years down the road, and then it will be someone else's problem. So they want to save the $300 now instead of the $3000 later.
The bottom line is that the billing system for health care in this country is fundamentally flawed. And in a capitalism-based society, the companies will make their money any way they can. It's wrong for the sleep lab to charge $3000 in the first place, the underlying service doesn't cost that much. It's wrong for the DME to overbill the insurance company. It's wrong for the insurance company to push their costs onto other insurance companies. Without radical overhaul, all of these gray-area things will continue to exist, and all the while the patients will be caught in the middle.
