12-04-2013, 08:37 AM
Insurance Frustration
Well, I called my insurance company yesterday to find out what the schedule was for replacing items. I don't trust my DME at this point. They told me that I did not have to be on a rental plan for 13 months that they would pay for it up front. I said great because I have already met every deductible this year because I had a hip replaced. They told me to just have it submitted in full and they would pay me in full. Well that sounded easy didn't it.
I called the DME and they sent me to the warehouse who sent me to billing. Billing didn't have a record of purchase because it was too soon. Then called back to my insurance company and they said that if it starts off as a rental then they have to pay it as a rental. I called my DME back and talked to a supervisor. They said they have never had an insurance company pay for the machine in full. That 99.9 percent check for compliance and none pay in full. I told her that I wanted the entire bill sent to the insurance company and not a rental. I want my $1500 deductible for next year. She has no clue on what to do. I started this process on Wednesday. Today I called and she said she has not come up with a solution.
At this point I know more about the machine, how to change my settings, how to read my settings and what the settings mean than the DME rep. I downloaded the software last night and read all my readings.
I then asked about ordering a battery. The insurance said they would cover it in full. I just have to find a DME that will order it for me. My DME said they only do the machines and the masks. Now I have to figure out how to find a DME that will order the battery.
I am pretty frustrated at this point. I called another DME today and they said they could not order the battery for me. Any ideas on who to call to order a battery for my machine?
UPDATE:
Get this. I have repeatedly called my insurance company to verify that I can outright purchase the CPAP machine. I can either purchase it or rent it. So I have been working for a week with my provider to have them stop the billing of a monthly bill that I would have to pay for a year or to bill it up front and be done with it. My deductible has been met. Well here is the new story.
After I called the provider they said they sent an email to billing. This was after a week I have not heard anything. I called her in the morning and in the afternoon and all I got was “I sent billing and email”. So I called my doctors office and talked to the sleep clinic. I talked to a woman and told her that my insurance will purchase it and no billing and that I have met my deductible and I want this done this year. They will also pay for a battery and I want that ordered. She was so shocked that she never heard of not being put on a 13 month plan. She said she would call the provider for me and find out what is happening.
The provider told her that because I have an out-of-state Blue Cross Blue Shield policy they have to submit it to the instate BC/BS policy and that they will reject an outright purchase. I told her then to submit it directly to my insurance company and be done with it. That I pay good money for this policy and this is what my benefits are. She said she was unable to do that. That Michigan has a policy that it needs to bill out for 13 months. I told her that this was unacceptable. I wanted to purchase it.
Now my insurance company gave me 250 other DME’s in my area (I have called 20 or so of them) and none of them provide CPAP equipment. If I order on line then I am responsible for it 100% because I am out of network then. I am screwed.
What the clinic told me was that the provider was trying to bill it through an Ohio office so that it would not go through Michigan’s red tape in their billing requirements. Is this a bunch of poop or what. I am furious that I have spent almost a week on this and have not gotten any results. When I talked to the provider they offered to come pick up the machine so that they did not have to deal with me any more. Instead of doing their job they wanted to come and pick up the machine. I told them that I had until the 11th of this month before that could happen. Now I am on search for a DME in my area that is in-network.
I want to scream. I have talked to my insurance yesterday and they have not come up with any solutions either. I don’t want to say anything about them billing through Ohio for fear that I will get screwed with that route.
Any suggestions would greatly be appreciated.
I called the DME and they sent me to the warehouse who sent me to billing. Billing didn't have a record of purchase because it was too soon. Then called back to my insurance company and they said that if it starts off as a rental then they have to pay it as a rental. I called my DME back and talked to a supervisor. They said they have never had an insurance company pay for the machine in full. That 99.9 percent check for compliance and none pay in full. I told her that I wanted the entire bill sent to the insurance company and not a rental. I want my $1500 deductible for next year. She has no clue on what to do. I started this process on Wednesday. Today I called and she said she has not come up with a solution.
At this point I know more about the machine, how to change my settings, how to read my settings and what the settings mean than the DME rep. I downloaded the software last night and read all my readings.
I then asked about ordering a battery. The insurance said they would cover it in full. I just have to find a DME that will order it for me. My DME said they only do the machines and the masks. Now I have to figure out how to find a DME that will order the battery.
I am pretty frustrated at this point. I called another DME today and they said they could not order the battery for me. Any ideas on who to call to order a battery for my machine?
UPDATE:
Get this. I have repeatedly called my insurance company to verify that I can outright purchase the CPAP machine. I can either purchase it or rent it. So I have been working for a week with my provider to have them stop the billing of a monthly bill that I would have to pay for a year or to bill it up front and be done with it. My deductible has been met. Well here is the new story.
After I called the provider they said they sent an email to billing. This was after a week I have not heard anything. I called her in the morning and in the afternoon and all I got was “I sent billing and email”. So I called my doctors office and talked to the sleep clinic. I talked to a woman and told her that my insurance will purchase it and no billing and that I have met my deductible and I want this done this year. They will also pay for a battery and I want that ordered. She was so shocked that she never heard of not being put on a 13 month plan. She said she would call the provider for me and find out what is happening.
The provider told her that because I have an out-of-state Blue Cross Blue Shield policy they have to submit it to the instate BC/BS policy and that they will reject an outright purchase. I told her then to submit it directly to my insurance company and be done with it. That I pay good money for this policy and this is what my benefits are. She said she was unable to do that. That Michigan has a policy that it needs to bill out for 13 months. I told her that this was unacceptable. I wanted to purchase it.
Now my insurance company gave me 250 other DME’s in my area (I have called 20 or so of them) and none of them provide CPAP equipment. If I order on line then I am responsible for it 100% because I am out of network then. I am screwed.
What the clinic told me was that the provider was trying to bill it through an Ohio office so that it would not go through Michigan’s red tape in their billing requirements. Is this a bunch of poop or what. I am furious that I have spent almost a week on this and have not gotten any results. When I talked to the provider they offered to come pick up the machine so that they did not have to deal with me any more. Instead of doing their job they wanted to come and pick up the machine. I told them that I had until the 11th of this month before that could happen. Now I am on search for a DME in my area that is in-network.
I want to scream. I have talked to my insurance yesterday and they have not come up with any solutions either. I don’t want to say anything about them billing through Ohio for fear that I will get screwed with that route.
Any suggestions would greatly be appreciated.
