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How long did it take before you knew your insurance coverage?
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novatom Offline

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Location: Reston, Va.

Post: #11
RE: How long did it take before you knew your insurance coverage?
(02-28-2015 12:22 PM)Luxsit5280 Wrote:  Anyone who has dealt with Insurance understands that the experience can be trying and painful at times. I first met with my PCP in November to discuss having a new sleep study done. It is important that along the way, you work through the process with your PCP, Sleep Center, DME and Insurance. I had to have two studies done, I was trying to get everything done by the end of last year, but the process took more time than expected.

Here's some things I learned:
If you get a referral from your PCP for a Sleep Study, call your insurance to check to see that the Sleep Center is in-network. If not, you are going to have an uphill battle.

Ask the Sleep Center which DME they work with? Some Centers push patients to specific providers, who may or may not be in-network for your Insurance.

Check out the proposed DME, look them up on BBB, do they have a supply program - where they ship you CPAP supplies on a 90 day cycle. The better ones do.

When you get the Sleep Study done, ask for a follow-up appointment with the Pulmonary MD. You should tell your Pumonary MD any other medical issues you have, Obesity, Hypertension, Heart Issues like AFib, Diabetes. These all need to go into the report that they write. You should get a Prescription that should have the type of Machine: CPAP/BiPAP and type of mask: Nasal Pillow, Nasal Mask, Full Face Mask, and your pressure setting. Make sure they don't put specific model/manufacturer on the prescription, this leaves you more flexibility in picking the equipment. You should get a copy of the Sleep Study and the Report from the MD. The report needs to have the correct codes.

Choose a DME, for some the choice may be limited to in-network providers. I use an out-of-network DME. I am not going to say why other than we have an arrangement that benefits us both. Some DME push certain equipment. Do some research, read the equipment reviews here. There's plenty of good information to help you choose. Most DME can order equipment that they don't normally carry.

I had a second BiPAP study done in mid-January. It took almost another month to get all the paperwork from the Sleep Center to the DME in a format they requested. It took a long time for the Sleep Center to post all my claims to my insurance. It took about a week and a half to get paperwork straightened out between my DME and Sleep Center. It seemed to be more painful that it should have been. Get the name of the contact with your DME, and talk to them weekly about the status. They are working on multiple patients at one time, and the squeaky wheel get attention. Don't be an a-hole, they are doing their job. Glacier speed it seems at times Smile

Be patient, be persistent, be respectful...

Regards,
Lux

Thanks for the advice, Lux. Apart from yesterday's experience, the rest of my experience over the past 3 months has been good, except for minor annoyances such as not being able to directly connect with my particular branch of the sleep clinic and limited office hours. I got reports of my sleep test and titration on both follow ups and I like my doctor.
02-28-2015 01:04 PM
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Mosquitobait Offline

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Post: #12
RE: How long did it take before you knew your insurance coverage?
Quote:I still don't understand why the monthly rental fees have to be so high. Huh I hate to think that pricing schemes like this, in some small way, affect my premiums.

They may not actually be that high. That is how it is billed, but it is paid according to the negotiated rate. I was stunned how high my hospital bill was ($45,000) and then saw the negotiated rates 2 months later - ($17,000). Now, granted, I am on Medicare and a supplemental now, but it was similar when I had an individual policy with Blue Cross before I became disabled.

As to my coverage, I contacted my insurance company before they did the sleep study to get rough estimates of cost. My sleep study and doctor's appointment is covered 100% including co-pays. I have to call them back now that I have been confirmed that I have apnea to find out more, but I know she told me that there was a monthly rental rate for either 12 or 13 months and then you own it. I only pay a small portion of that.
(This post was last modified: 04-15-2015 03:56 PM by Mosquitobait.)
04-15-2015 03:52 PM
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Mr. Van Winkle Online

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Post: #13
RE: How long did it take before you knew your insurance coverage?
(02-28-2015 12:55 PM)novatom Wrote:  
(02-28-2015 11:04 AM)Homerec130 Wrote:  Novacom,

Hang in there. Having the wrong code submitted and denied is a very common occurrence, especially when first starting a treatment plan. I get it all the time. The facility that charged you simply resubmits with the proper code.

Network vs non-network depends on the insurance. With my insurance, the difference only means how much I am responsible. It is very common for doctors in the same practice to have different network status. And, it is very common for a network doctor to use a non-network facility. Remember, they are dealing with multiple insurers whereas you and I usually only one or two at a time.

Hope this answered some of your questions.

Homer

Thanks, yes I've had this experience before with my insurance company. But insurance or not, it's all still worth it to me.

I still don't understand why the monthly rental fees have to be so high. Huh I hate to think that pricing schemes like this, in some small way, affect my premiums.

I only had to rent for 2 months and own on the 3rd, But I know it's a shame how our systems works, I think most of our systems are broken like Taxes.... oh better not get started there, ( tax day).
Anyway your right it all affect our bottom line, just think if we didn't have insurance, most of us would be dead, couldn't afford it..... well maybe not then we wouldn't be gouged so much. who knows?
Anyway
Sleep-well
04-15-2015 04:25 PM
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trailrider Offline

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Post: #14
RE: How long did it take before you knew your insurance coverage?
Call the DME and the insurance company and ask. Maybe someone moved a decimal point. Maybe use it to convince your insurer to purchase one outright for you. Use the opportunity "to clarify" what supplies limits there are.
04-15-2015 08:37 PM
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