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Can the DME do this to me?
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #11
RE: Can the DME do this to me?
(06-22-2015 12:11 PM)Ailu Wrote:  
(06-22-2015 10:05 AM)justMongo Wrote:  I think of the Sierra Nevada's being in the state of California... however, that's not exactly true as they extend into Nevada.
My point is: In CA, there is Anthem Blue Cross and Blue Shield of California. Separate companies that pay to use the BC and BS name.
As far as I know there is no BCBS unified insurance company in CA.

Of the two flavors of BC and BS in CA, I believe they do rent to own.
That permits them to reclaim the machine if the patient in non-compliant.

Yep, here in Northern California, Anthem Blue Cross is a for-profit, Blue Shield is non-profit. Not that it makes much difference, I've heard... but I can tell you that very few docs up here will partner with Anthem. But most of them take Blue shield.

(06-22-2015 10:34 AM)OpalRose Wrote:  I would call your insurance again. Chances are you will talk to someone else and get a different response. The norm for insurance is to "buy" by paying rent to the DME for a set amount of months, then ownership is transferred to you.

As justMongo stated, they do this so that they can reclaim the machine if you don't meet compliance.

I know it's a pain to deal with these people, but hang in there!

Well crud!!! I took your suggestion and called Blue Shield to ask again. This time I got a CSR who actually wears a CPAP! After checking, he told me that there is no provision to buy, only to rent. Ugh! 4

My copay is 10% of whatever the rental is. What's the deal with renting? Do I have to rent the machine forever? Or do they usually do a "rent to own"?

Ailu,
You do not pay the rent, your insurance pays it. You should only have to pay the copay.

I'm on Medicare, so they pay my DME rent for 13 months, after the 13 months is up, I own the CPAP. I'm not sure, but I think most insurances operate in the same manner.

OpalRose
06-22-2015 02:04 PM
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me50 Offline

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Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
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Post: #12
RE: Can the DME do this to me?
(06-22-2015 12:15 PM)parkerdt Wrote:  I see your concern, now. My guess would be (and it is a guess) that your DME can bill you for the co-payment (10%) but is going to bill your insurance for the 90% that is covered. How your insurance reimburses the DME is really out of your control. Just make sure you are in compliance, and they are not going to take it away. Compliance is usually 4 hours/night on 70% of the nights during the first 90 days.

I did see the paperwork from my DME to my insurer; I had to initial that I'd in fact received the machine, verify the serial number, etc. My insurance was billed $2000 for my ResMed. And something for the mask of course, but I don't know that part....

So your co-pay is likely to be in the $200+ range assuming pricing is similar, which it may or may not be. Now whether the spread your co-pay over some rental period is a question only your insurer can answer with certainty. Likewise, they are the ones who can tell you what the rental time period is.


Dave

Your copay will NOT be 10% of the amount that the DME bills the insurance company. It WILL be 10% of the contracted amount. Before you pay the DME any payments, look at your EOB so you don't get charged more than you are supposed to. NOTE: the 10% is if you are using an in network provider.

Here is an example:

Billed Amount $265.00

Exclusions
$165.92

Plan paid
$54.08

Your copay amount
$45.00

If you add what the plan paid and my copay amount it will total the billed amount less the exclusion amount which is 99.08.
(This post was last modified: 06-22-2015 02:40 PM by me50.)
06-22-2015 02:28 PM
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parkerdt Offline

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Machine: ResMed A10 AutoSet
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Post: #13
RE: Can the DME do this to me?
Thanks. I don't have much experience with this co-pay thing (obviously) since my insurance pays 100% for CPAP and supplies.

In your example above it looks to me like it was roughly a 45% co-pay.

Dave
(This post was last modified: 06-22-2015 05:56 PM by parkerdt.)
06-22-2015 05:53 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #14
RE: Can the DME do this to me?
(06-22-2015 05:53 PM)parkerdt Wrote:  Thanks. I don't have much experience with this co-pay thing (obviously) since my insurance pays 100% for CPAP and supplies.

In your example above it looks to me like it was roughly a 45% co-pay.

Dave

the example I gave above was just an example and not an example for CPAP/VPAP and/or supplies. It was an example to show that it doesn't matter what the DME bills the insurance company, the insurance company will deduct money so that the amount is equal to the contracted amount. Hope this makes sense.

Watch your bills from the DME because they don't always get it right, especially if it is Apria. I am dealing with one right now for an x-ray and MRI that doesn't match my EOB.
06-22-2015 08:51 PM
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Terry Offline

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Post: #15
RE: Can the DME do this to me?
(06-22-2015 09:03 AM)Ailu Wrote:  Can the DME make me rent the machine when my Insurance allows me to purchase it outright from them?

Tell the DME that they can either sell it to you or you'll go somewhere else.

Top-shelf auto machines are about $800 online with no insurance, which is probably only a few hundred dollars more than you'll end up paying in "rental".

Only you can decide if the money is worth the annoyance.

I rented my first machine, but will just buy the second one. It's just not worth the annoyance.
06-22-2015 09:38 PM
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Terry Offline

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Posts: 553
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Machine: Philips Respironics RemStar Auto with A-Flex (560P)
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Mask Make & Model: P/R Nuance & Pap Cap
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CPAP Software: SleepyHead

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Post: #16
RE: Can the DME do this to me?
(06-22-2015 01:26 PM)Adoniscmj Wrote:  I took my machine back and purchased one online, because the DME was charging me for the humidifier and it is part of the machine, not separate. I have a ResMed Air Sense 10 Auto Set. I asked them about this and their explanation didn't make sense to me. I said that is like buying a car stereo and paying extra for the CD player even though it is integrated with the stereo. I have filed a complaint with the Attorney Generals office about this. So go over your bill very carefully. I would just buy online before I will ever deal with these local DME crooks ever again.

You too?

I was charged for a bag containing a mask and headgear and nose-pieces, then billed again for the headgear and the nose-pieces as replacement parts, even though all I got was the bag containing everything.

And they wouldn't back down. Told me "they had to bill it that way".

Want to hear something even funnier. I called BC/BS's fraud hotline and it's disconnected and the BC/BS phone rep didn't want to hear about it.
(This post was last modified: 06-22-2015 09:42 PM by Terry.)
06-22-2015 09:41 PM
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OpalRose Offline

Monitors

Posts: 3,181
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #17
RE: Can the DME do this to me?
I order a P10 for her from DME. They charged my insurance $169.00 for the mask. Then they turn around and charged in addition a separate charge for the nasal pillows @ $60.00 and headgear @ $69.00. That's almost $300.00. I know they weren't reimbursed all that, but still reimbursed far more than is sold on line.

I did the same and complained to my insurance even though I am only paying 20% of whatever the amount insurance reimbursed them (don't remember now), but my point being that insurance didn't see anything wrong and told me the same...that is the way it is billed. Bug-eyed

OpalRose
(This post was last modified: 06-23-2015 06:26 AM by OpalRose.)
06-23-2015 06:20 AM
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