Help! DME Over-Charging!

[arpeggioh]

It's my first post, so I'll apologize in advance for length, because my need for advice is pretty deep.  I'm only 6 weeks into BiPap therapy, running a fancy new ResMed AirCurve 10 VAuto that was prescribed following a sleep study.  At my consult, I was asked "Which DME do you want to use?"  Never having dealt with any company before, I chose Lincare because their office was in the town nearest my home.  I was set up by a very nice RT on November 12, who brought the machine and an oxygen concentrator that was also prescribed (I have COPD, O2 levels were dropping into the seventies at my sleep study.)  I signed many forms that day, receiving zero copies for myself.  When I asked how much this would cost me, he scribbled some numbers on a Post-it note (no cost until next year, insurance will cover; starting January, $255 a month until deductible is met, then 50% thereafter.)  I balked, but figured I'd find a way to make the payments somehow, with some assistance from family and the church where I work as a musician.

I've received my first bill from Lincare, and the prices they're billing my insurance company are mind-blowing!  $512 for a full face mask; $190 for a replacement cushion; $632 for "Rent Bi-pap," whatever that means, absolutely no clue on length of rental or total cost for the machine.  I'm sick with worry, scared I've signed up for a long financial screwing by this company, and determined to cut myself free and purchase my own equipment out of pocket. I dread making the call where I say, "I can't afford the payments on this equipment, and I need to return it immediately."  I'm expecting all manner of threats and charges...

I will finance an online purchase of everything I need, and save thousands of dollars.  My physician is willing to fax my prescription wherever I choose to buy.  But can anyone advise me on terminating this horrifying contract with my DME?  Every night I use their equipment, I'm incurring massive debt, and I'm beginning to panic.

[OpalRose]

Call your insurance and find out first hand what your coverage is.  Some require renting for a period of time, then you take ownership.  

Never believe what a DME tells you!  It does sound like you are being raped.  

Lincare doesn’t have the best reputation.  Although very few are a joy to deal with.

First step...get information from your insurance company.  Do you have to meet a deductible?
Is there a copay on supplies?  Do they require that you rent the machine?  What is your portion of cost.  

Next...get copies of everything you signed!  

Compare online prices to your DME cost.  If your deductible is high, you may want to go that route.  Check Supplier #2 for prices.  They sell new open boxed and gently used.
Also Supplier #33 runs sales with decent prices.  

If it turns out to be cheaper to buy outright, return the machine!

[Sleeprider]

The first step in selecting any DME is to determine if they are in-network for your insurance. You can call your insurance company or go online to obtain a list of local doctors and DME providers that are in-network. Buying out of network offers no protection, but in-network providers have negotiated a price for each service or device, and that is normally well below retail. The prices you are quoted are much higher than buying out of pocket. If Lincare is out of network you must find a way to escape the contracts you signed and return the equipment. If they are in-network then the costs you are seeing are going to be different. Your insurer is the first stop to determine your next step.

You can buy devices on the used marketplaces like Craigslist, Offerup, Facebook, etc. The cost of a near-new Vauto can b $400 to $800 on those channels. The cost through Supplier #2 is under $900. Masks are available through online suppliers at under $200 complete, and for nasal pillows they are often under $100.

You should download the free OSCAR software that can read a SD card (look behind the door on the left side of your machine) that contains all the therapy data. We can help you to understand more about your machine, settings and the effectiveness of the therapy. The Vauto is one of the best machines I now of for obstructive sleep apnea, and I'm curious why you were prescribed a bilevel rather than CPAP. You may want to post copies of your sleep study with personal information blacked out (redacted).

[SarcasticDave94]

Welcome to the Apnea Board. Like was mentioned, first call is insurance and find out who's in network for you and what the coverages and copays are. Second, Lincare needs to provide bills if you're expected to pay. If they won't, which IMO is bordering on illegal if not outright, then I'd consider returning everything you don't own in person and make them sign a detailed return receipt. Or alternate is make a video of returning it, it might be acceptable proof.

PS it would also be helpful to see a redacted sleep study. With COPD, you're probably going to need a machine that works well with that. VAuto might be fine as I've not had one. I think you'll need breath timing controls to help machine play well with COPD.

[arpeggioh]

Oh, there's no question I'll save money by purchasing my own machine, and bypassing my insurance.  I have a fairly high deductible on a new policy starting in January, and even then, DME coverage is 50%.  That's 50% of normal pricing, not the jacked-up numbers I'm seeing on this first statement.

My main concern: I've never heard from anyone who tried to return rented equipment and "break" a documented agreement with Lincare, and I'm expecting a fight, and additional outrageous charges that I can't afford to pay. 

Thanks for the supplier suggestions; I, too, question my need for a BiPap, even question my doctor's motives in prescribing one, now that I see the amount of money flowing between DME and insurance companies.  I have to assume he profits more from prescribing $2000 machines...but I'm too new to this game to disregard his recommendation.  I'm having enough trouble getting a hard copy of my prescription mailed to me; they've offered to fax it to a supplier, but act confused about sending it to me directly.  My suspicions about the sleep therapy industry are on high alert right now!  Very grateful that I found this forum...

[Osiris357]

Lincare tried billing me for a $450 mask also along with a rental charge for the machine. My insurance pays for the machine they don’t rent it and there was no way I was paying $450 for something I can get for $150. When I called the response was filled with stuttering and stammering (IIIII WE WE WE WE) 

What I did was I called my insurance company and she actually called Lincare with me on the line. They had an excuse for everything and in the end “I wasn’t supposed to have received that bill”.

[SarcasticDave94]

This rental aspect involves compliance assuming insurance payment is involved. If one fails said compliance, the machine is returned. That ends the contract, it's what happened to me twice when CPAP and BPAP weren't compatible with my COPD.

[SuperSleeper]

Just a note of caution for anyone who signs any "contract" for services.   Never give them your social security number.  Because if they "decide" that you've somehow broken the "contract", they can then negatively affect your credit rating by falsely reporting an "unpaid bill".

They don't need your soc sec number to enter into an agreement with you, so never give it to them.  Usually it's front-line staff that "insists" you give it to them, and if you ask to speak to the manager and stand your ground, you'll find that it's not necessary to give it to them.  If they still insist upon you giving it, leave.  If they need a number for billing, ask them to create a random number for that purpose and use it instead of your soc sec number, of if it's a computer field that simply must be filled in, use all zeros instead.

You're under no legal obligation to reveal your Social Security number to a health care provider, at least not in the United States.

[arpeggioh]

Thanks for this; I'm encouraged because I only gave up my signature on multiple documents, not my SS#.  I'm feeling a bit more confident that I can dump this company without too much blowback.  I've purchased a "refurbished" machine and new mask which should arrive next week, no prescription needed.  I will, however, need some guidance with pressure settings from you good people here, since I'm also divorcing my sleep doctor, unless his office gets a lot more forthcoming with my requested documentation.  I now want a copy of my sleep study results; it's my information, and I'm entitled to see it, and I'll gladly post it here for detailed suggestions.  I trust the motives here much more than his, unfortunately...and I know you're not doctors!  I'm good with that.

[Sleeprider]

We will be glad to help you optimize the new machine, especially if it provides data. What did you get?

I have moved this thread from Off-Topic to our main Apnea Board Forum. This is not off-topic.