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[Equipment] DME troubles
06-06-2015, 12:51 PM
So I am newly diagnosed and had my day with my DME to pick up the equiptment. The first visit I had told them on the phone that I would like the ResMed AirSence 10 Auto Set. The lady I talked to said we carry it and to talk to your respitory therapist when you come in. The day of my appointment I walked in and she had a PR system waiting for me and I told her I don't want that one. Mind you that I am not saying anything bad about it but my preference is the ResMed unit. So she reluctantly said ok and I had to make another appointment to get the unit I wanted as she stated it is a real hassel dealing with ResMed software. I think they get a kick back from Phillips to push their machines, I don't really care I am the one who has to live with it for the next five years until my insurance will pay for a new one. This brings me to my main subject for writing this. I saw the bill from the DME and they will bill me $60 dollars rental on the humidifier. I found out that my insurance doesn't cover humidifiers at all so I will have to $60 dollars per month plus the machine. The AIr Sense 10 has the humidifier integrated into the unit so you can't buy it without. The older machines had the humidifier seperate so you can choose to buy it or not. I think this charge is borderline fraud and I intend to report it to the local BBB. I don't see how they can charge me for something that comes with the machine. It should be one charge. If I have to pay it I will be taking it back to them and buying one online as it will be about the same cost and I don't have to worry about compliance. I think that they do this because no one stands up to them and tells them that what they are doing is fraud and I wont pay this charge. Has any one else had a similar situation with their DME and If so how did they resolve the problem? I hate these DME's they only seem to care about proffit. Mine didn't spend any time with me to choose a mask I was given one and explained the compliance then kicked out the door.
06-06-2015, 03:05 PM
Just got my first bill from my insurance. They were also bill for the humidification unit. I plan to call them on Monday to say the unit is included should it be billed separate? Will update once I get an answer.
06-06-2015, 03:27 PM
Buying your unit from one of our on-line suppliers seems a no brainer to me, if you're comfortable in doing the research to set the machine up properly, monitor the results and make any adjustments necessary. Which, by the way, you would probably have to do anyway even if you stick with your DME. There are lots of folks out here that will help you along the way.
I don't know how the insurance part of it will work. That probably varies from policy to policy, so call your insurance folks and ask. But as you say, if you're going to get dinged $60/month for just the humidifier, and probably a considerable deductable for you masks and supplies, your number one stop should be to fax a copy of your script to cpaps-are-us (actual name to be determined from our on-line supplier lists)
(06-06-2015, 12:51 PM)Adoniscmj Wrote: I saw the bill from the DME and they will bill me $60 dollars rental on the humidifier. I found out that my insurance doesn't cover humidifiers at all so I will have to $60 dollars per month plus the machine. The AIr Sense 10 has the humidifier integrated into the unit so you can't buy it without.
Can you cancel the order and to go another DME? Are you dealing with Crapria? The humidifier is NEVER part of the rental. All the insurance companies follow the same pattern - the humidifier is charged separate (even for an integrated unit) and is paid for all at once - it is not a rental. Integrated units are new and no coding exists for them -therefore, the DME IS CORRECT in charging you for a separate humidifier despite the fact that it is part of the machine. What they can't do is have a separate rental for it. If they won't even go over masks with you, then go to another in-network DME. You could also contact your insurance company to find out if they will reimburse for an out-of-network DME and buy your stuff online. If you have original Medicare, this isn't an option however.
06-06-2015, 04:54 PM
Did the DME or your insurance say they would't cover humidifiers? I've never heard that before. Check with your insurance to be sure.
Insurance/Medicare does not pay "rent" for a humidifier, instead they purchase it...a one time price. They pay rent on the machine.
If the DME is trying to charge you rent and got paid by insurance, then that is fraud!
How to Organize and Post ScreenShots
06-06-2015, 05:33 PM
Tell them, you don't want the humidifier and don't want to pay for it either
They can give you a side cover for the A10 instead the water chamber and the machine can be used without engaging the humidifier
You can buy yourself a water chamber on-line
Water chamber does not require a prescription but might as well have a copy for yourself to keep
06-06-2015, 06:23 PM
My DME is Norco. My insurance doesn't cover humidifier's under their DME policy so I would imagine that it isn't covered. I have private insurance through my work. I noticed on the statement from the DME that the $60 dollar charge is a rental and that to me means it will be charged every month. If this is the case I will bring the thing back to them and purchase it online. If they fix it so I don't have to pay the monthly rental on it then I guess I may keep it, but just because the unit is new and has the humidifier included doesn't mean that they should be able to charge me as if it were separate. There is no way to purchase it without. I intend to file a complaint with the BBB I think they are taking advantage of the situation. They are used to machines that don't come with them so they get to bill them as an add on, so on these they still want to get that money so they bill it as if it were separate. In contrast I work in class A truck parts and when I sell a set of brakes to a customer they ask if they get the brake hardware kit with the brakes, as some of the brake sets do not come with hardware. The brakes we sell come with hardware and If I did as the DME I would charge them extra even though the brakes come with it. That is fraud if I did that so I can't see the difference here. The problem is these machines are new and the billing rules need to be updated for the new product. It will not change unless the insurance company's figure it out and say no way. However mine doesn't care as they clearly state they will not cover the humidifier. I will call the DME monday and ask them about it and I will call my insurance to make sure I understand the policy. Thanks for the reply's I really appreciate them.
06-09-2015, 10:26 AM
Talked with my Insurance yesterday. Their auditors say that the DME can charge for the Humidifier, even if it is attached. They suggested that I could take the issue up with the DME and convince them not to bill for it. But that if they billed for it then the Insurance would pay for it. Got to love our Medical System.
Still seems questionable to me.
06-09-2015, 11:37 AM
It is Fraud, and I am going to let the Wa. State attorney general know what is going on. I have also talked to the state insurance commish. and they said that there are no laws about this kind of thing, this is why they do it and get away with it. They said if enough people complain about it then it may spark an interest with the attorney general to do something about it. If they don't take it off my bill I am going to give the machine back to them and purchase it online. I will not be charged for something that should be included.
06-09-2015, 11:57 AM
Good luck. Medicare doesn't consider it fraud. As mentioned, there is no code for an integrated unit. Therefore, you get two codes for one unit. At $60 a month rental for the machine alone, really, you are better off returning the unit and getting it online. Do the math.
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