Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Are "Up Charge" Costs Legal in NY for a better Machine?
#1
Are "Up Charge" Costs Legal in NY for a better Machine?
I have been working hard on learning more about my sleep disorder and trying to figure out why current treatment hasn't worked (approx. 22 months). It seems that the machine may be the culprit and the only way to know is to switch. There is no doubt I need an AutoPap from all the information I have learned and as I shopped around for one I find most DME's aren't being honest with different reasons why I don't need one. Recently I found a DME who has the AutoSet but says there is an, "Up Charge"! Is that legal in NY when the S9 AutoSet is the same insurance code for an S9 Escape, E0601?
Tim
Finger Lakes Region, NY
Post Reply Post Reply
#2
RE: Are "Up Charge" Costs Legal in NY for a better Machine?
Rather than "government illegal," it's probably against their contract with the insurance company if they're an "in network" provider.

It might be "government illegal" as well, depending on state law, and whether the state regulators care.

However, they are probably not required to provide an AutoSet, just a CPAP that fulfills the requirement of the the prescription. Writing "Dispense as written" doesn't obligate the DME to provide that model either, but they may not legally be able to dispense another model of machine.
Get the free OSCAR CPAP software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
Post Reply Post Reply
#3
RE: Are "Up Charge" Costs Legal in NY for a better Machine?
Thank you for the reply. They are a "in network" provider that I obtained from the insurance companies web-site. They wanted me to sign a waiver for I believe $2000.00 if the insurance company denied the prescription. I have a Customer Care worker that totally understood my position and is behind me in getting the new machine. We are working now on a Pre-approval. It would seem if they are contracted with the insurance company they should fill whatever prescription they receive if it is an item they stock in an area they specialize in. But all of this is new to me as I haven't really dealt with this type of situation before.
Tim
Finger Lakes Region, NY
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
Exclaimation CPAP Machine Choices - read this before you accept a new machine SuperSleeper 283 262,211 11-10-2023, 10:24 AM
Last Post: robbob2112
  Rant about insurance, sleep study, and costs Stuff 8 1,144 06-20-2023, 08:37 PM
Last Post: cmpman1974
  machine died! Now new doctor and new machine Bjazzman 17 6,799 09-05-2022, 09:07 PM
Last Post: NValtman11
Question [Equipment] Is it legal for DME providers to decline a CPAP device without Credit Card info? ngxt25 10 1,792 08-12-2022, 06:17 PM
Last Post: YipeekiOH
  [CPAP] Using SoClean Machine with CPAP Machine ronald1810 4 1,321 06-01-2022, 10:18 PM
Last Post: Sleepster
  [News] Privacy Policy & Legal Notice SuperSleeper 0 706 07-12-2020, 03:23 PM
Last Post: SuperSleeper
Gross [News] Sleep apnea is massively undertreated and costs billions in health problems JoeyWallaby 16 2,388 01-01-2020, 09:01 PM
Last Post: LeonardoDR


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.