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Problem with insurance
#1
Problem with insurance
So the problem I am having I have been issued a resmed Air sense 10 I have to rent it for 11 months per insurance. So they charged me a one time fee for the water chamber. Then every month they are charging me for the Air sence 10 the an additional charge for internal humidifier. Does this make since the humidifier is part of the machine not a seperate part Insurance is claiming it is separate.   Am I missing something

Thanks for your help
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#2
RE: Problem with insurance
no, you aren't missing anything.

I'm in an ongoing dispute with the dme provider that set me up with a resmed apap that I no longer use. this was 2.5 years ago. they charged me for receiving the cellularly transmitted data from the machine. the tax they charged on the inflated prices sent to the insurer is the same tax amount they charged on the lower prices the insurer allowed. more to your point, they charged for the humidifier and charged for the chamber, both of which are standard equipment (not optional) and are included in the retail price. finally, they charged for an exhalation port in addition to the charge for the airfit p10 assembly even though it's one piece with the mask frame, not optional and can't be removed or replaced. it too is included in the retail price of the airfit p10 mask frame.

in contrast to previous repeated denials that their billing is in error, they've recently come around to admit some of the lesser charges shouldn't have been charged. still, as often as I've asked in person and in writing, they've yet to explain how they can justify this double charging. strikes me as fraud.

it makes sense that there are codes to charge for these things separately. in the past, humidifiers were an optional separate purchase. or we might have to buy a new one as a replacement part. or if we want a stand alone humidifier for some reason. similar with the exhalation port. IDK but that they are a separate part with some mask systems. and there are times when one might want one if doing some modification, like increasing rebreathing space to minimize co2 consumption (not sure if I have that just right but you get my meaning).

just because there's a code for something doesn't mean it's right to charge for it but this seems to be a rampant problem among brick and mortar dme providers. when I complained to my insurer, they punted to the provider. when I complained to my provider, they punted to the insurer. I'm afraid that pretty soon they're going to send me to collections without telling me how this practice is justified.

in the absence of an arbitor (small claims court? state offices like AG, insurance or health? not much encouragement from any of them when called) and in the absence of good faith from the dme provider, I suspect I'll end up having to eat it to avoid collections and a ding on my credit rating.

fight 'em! no one without the cover of this enormous health care and health insurance bureaucracy could get away with this.

edit: there's some logic to charging you for the humidifier because it's a consumable item. but in fairness, it should be credited back once you own the machine.
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#3
RE: Problem with insurance
Nope, you got it.


Originally you needed to get the humidifier as a separate addon, there was no integration.  This old style of charging has lingered and will continue to linger as long as the insurance companies let it.
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#4
RE: Problem with insurance
My ResMed AirSense 10 AutoSet came with the humidifier and a Climateline heated hose. It also came with an AirFit F20 complete mask / headgear. 

My insurance picked up most of the cost. I paid $64.00 cash up front when I went in to pick it up. I pay $9.06 per month and I'm doing that for 13 months. October 10th, it will be paid for in full and will be totally mine.
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#5
RE: Problem with insurance
yeah but look at your Explanation of Benefits to see if they itemized the machine parts ala carte. look for a separate charge for the humidifier. if my insurance paid and I wasn't paying out of pocket against a very high deductible, I wouldn't have noticed, and if I did I probably wouldn't have cared as long as I didn't have to pay it.
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#6
RE: Problem with insurance
What you're experiencing is normal and acceptable.  It's how things are done. 

Of course, if we look at it with non-insurance eyes, it's obvious that it's messed up, and not right.

But ultimately, you're being charged like everyone else is. It's technicalities, when they say a humidifier isn't a required/necessary part of the machine.
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#7
RE: Problem with insurance
I guess I'm lucky they didn't charge me for the power cord (that is detachable)
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#8
RE: Problem with insurance
(05-29-2019, 07:05 AM)Frogbit Wrote: I guess I'm lucky they didn't charge me for the power cord (that is detachable)

Careful! The DME probably just heard that and editing their scheme ASAP.

Agreed on the why there's separate charges for the base machine and a humidifier even though they may be considered a unit. Flawed, shady, possibly crooked? Likely. Yet both DME and insurance OK-ish with it. IMO it tends to increase cost to the consumer somehow, either with charges not covered or increases in insurance premiums, or both.

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#9
RE: Problem with insurance
"edit: there's some logic to charging you for the humidifier because it's a consumable item. but in fairness, it should be credited back once you own the machine." - me, above

on further reflection, the humidifier chamber is a consumable but probably not the humidifier itself since it's built in. maybe they replace the humidifier if you don't end up with the machine but I'm skeptical.
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#10
RE: Problem with insurance
(05-28-2019, 07:41 PM)Frogbit Wrote: So the problem I am having I have been issued a resmed Air sense 10 I have to rent it for 11 months per insurance. So they charged me a one time fee for the water chamber. Then every month they are charging me for the Air sence 10 the an additional charge for internal humidifier. Does this make since the humidifier is part of the machine not a seperate part Insurance is claiming it is separate.   Am I missing something

Thanks for your help

As others have noted, once upon a time CPAPs had separate, optional humidifiers, and Medicare paid for it separately under separate billing codes. Now CPAPs come with integrated humidifiers but greedy equipment providers continue to max out the billing by billing both codes even though there is only one unit. This weird gaming of the system is considered normal, even though it is ridiculous.
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