Post Reply 
Question about billing/insurance
Author Message
Deej Offline

Members

Posts: 6
Joined: Feb 2016

Machine: AirSense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: Philips Nuance Pro
Humidifier: AirSense 10 Auto
CPAP Pressure: 8-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #1
Question about billing/insurance
I got an Airsense 10 Autoset back on 2/2. When I was at the DME office, no mention of charges or payment was made. Today I get a bill from the DME saying insurance paid nothing and they have billed me for a "6 month rent to own" for the machine. Is this a normal set up? It is 6 payments of $130. I just wanted to see if this sounded like the norm for the rest of you.

However, there is another charge that seems totally bogus to me. I was charged $260 for the humidifier and tubing. On the resmed website, it says the machine includes tubing and the humidifier is integrated.

What do you think? Are they trying to scam?
03-30-2016 02:45 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #2
RE: Question about billing/insurance
Well, I would be upset, that sounds a lot like the car dealer giving you the keys and a week later saying they couldn't get the financing.

As for price - going price for a ResMed Airsense 10 Autoset online is about $880 to $900 - that includes the tank and hose and stuff.

You are being charged $1040 for your system in a rental agreement/plan. Most rentals I have heard of are for 10 months and run about 300% interest - meaning you would pay about $2400 for the machine.

So, from one perspective, you could have possibly saved about $150 if you had purchased it outright. But, I don't know what taxes would be in your area (assuming none). $150 premium does not sound like a rip off to me. I would have prefer to have been told that was a possibility up front, but it could be a lot worse.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
03-30-2016 03:16 PM
Find all posts by this user Post Reply Quote this message in a reply
bwexler Offline

Advisory Members

Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #3
RE: Question about billing/insurance
FrankNichols assessment is correct.
It is common for brick and mortar DMEs to bill seperately for the integrated humidifier.
It is also common for the rental period to run 10 or 13 months.
I recommend you contact your insurance company directly and get a written explanation from them of what they will or will not pay for XPAP and why.
It is not uncommon for DME to neglect to bill the insurance company and then tell you the insurance refused to pay.
Under NO circumstances would I give my credit card information to a DME. It would be the same as signing a book of blank checks and handing it to them.

And never forget, "if it is midnight and a DME tells you it's dark outside, go out and check yourself ".
03-30-2016 03:32 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #4
RE: Question about billing/insurance
On my system (I am still waiting after 9 days - grrr) I made sure they were getting preauthorization prior to delivery. On pick up I will confirm both with them and with my insurance company.

BTW, I don't know what insurance you have, but Medicare requires a 3 month compliance test followed by a 10 month rental. or they won't pay.

I also agree with bwexler, and I would contact my health insurance and see why they refused to pay. If they did not, then return the machine and walk away or file a complaint with the insurance company about the DME.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
03-30-2016 03:44 PM
Find all posts by this user Post Reply Quote this message in a reply
0rangebear Offline

Advisory Members

Posts: 341
Joined: Jan 2016

Machine: ResMed AirSence 10
Mask Type: Other
Mask Make & Model: Amara View
Humidifier: HumidAire (Built-in)
CPAP Pressure: APAP 12.8-15 EPR 3 (cmH2O)
CPAP Software: ResScan SleepyHead

Other Comments: Ramp off

Sex: Male
Location: Brighton Colorado

Post: #5
RE: Question about billing/insurance
(03-30-2016 02:45 PM)Deej Wrote:  I got an Airsense 10 Autoset back on 2/2. When I was at the DME office, no mention of charges or payment was made. Today I get a bill from the DME saying insurance paid nothing and they have billed me for a "6 month rent to own" for the machine. Is this a normal set up? It is 6 payments of $130. I just wanted to see if this sounded like the norm for the rest of you.

However, there is another charge that seems totally bogus to me. I was charged $260 for the humidifier and tubing. On the resmed website, it says the machine includes tubing and the humidifier is integrated.

What do you think? Are they trying to scam?
To give you a comparison
I got the same machine on 12/27 My insurance negotiated $1200 for the month and set up and $170 each month for three months once they had proof of compliance each that month. That's a total $1740 smackaroos. Humidifier headgear tubing and mask with two replacement cushions was included.

2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
(This post was last modified: 03-30-2016 04:02 PM by 0rangebear.)
03-30-2016 03:59 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #6
RE: Question about billing/insurance
(03-30-2016 03:59 PM)0rangebear Wrote:  
(03-30-2016 02:45 PM)Deej Wrote:  I got an Airsense 10 Autoset back on 2/2. When I was at the DME office, no mention of charges or payment was made. Today I get a bill from the DME saying insurance paid nothing and they have billed me for a "6 month rent to own" for the machine. Is this a normal set up? It is 6 payments of $130. I just wanted to see if this sounded like the norm for the rest of you.

However, there is another charge that seems totally bogus to me. I was charged $260 for the humidifier and tubing. On the resmed website, it says the machine includes tubing and the humidifier is integrated.

What do you think? Are they trying to scam?
To give you a comparison
I got the same machine on 12/27 My insurance negotiated $1200 for the month and set up and $170 each month for three months once they had proof of compliance each that month. That's a total $1740 smackaroos. Humidifier headgear tubing and mask with two replacement cushions was included.

Thats bad too, I have heard worse still.

My intention is to get all the numbers up front when I go in and if the total is over $600 out of my pocket, (I pay 20% of the cost my insurance pays 80% and no deductible) I plan to simply walk away and pay cash for one online. I do not want to deal with crooks. $300 more than buying it through my insurance is my pain threshold - meaning $900 online vs $600 via my insurance/DME.

They are now a week late calling me to arrange for me to come in and get the machine (I was told 3 to 5 days). I called 2 days ago and they said I would be called within 48 hours to schedule the meeting. This morning was 48 hours. They are treading on thin ice. Another week and I cancel and send a letter to the insurance company and medicare about my dissatisfaction with Humana's ONLY DME Aprea.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
03-30-2016 04:38 PM
Find all posts by this user Post Reply Quote this message in a reply
0rangebear Offline

Advisory Members

Posts: 341
Joined: Jan 2016

Machine: ResMed AirSence 10
Mask Type: Other
Mask Make & Model: Amara View
Humidifier: HumidAire (Built-in)
CPAP Pressure: APAP 12.8-15 EPR 3 (cmH2O)
CPAP Software: ResScan SleepyHead

Other Comments: Ramp off

Sex: Male
Location: Brighton Colorado

Post: #7
RE: Question about billing/insurance
(03-30-2016 04:38 PM)FrankNichols Wrote:  
(03-30-2016 03:59 PM)0rangebear Wrote:  
(03-30-2016 02:45 PM)Deej Wrote:  I got an Airsense 10 Autoset back on 2/2. When I was at the DME office, no mention of charges or payment was made. Today I get a bill from the DME saying insurance paid nothing and they have billed me for a "6 month rent to own" for the machine. Is this a normal set up? It is 6 payments of $130. I just wanted to see if this sounded like the norm for the rest of you.

However, there is another charge that seems totally bogus to me. I was charged $260 for the humidifier and tubing. On the resmed website, it says the machine includes tubing and the humidifier is integrated.

What do you think? Are they trying to scam?
To give you a comparison
I got the same machine on 12/27 My insurance negotiated $1200 for the month and set up and $170 each month for three months once they had proof of compliance each that month. That's a total $1740 smackaroos. Humidifier headgear tubing and mask with two replacement cushions was included.

Thats bad too, I have heard worse still.

My intention is to get all the numbers up front when I go in and if the total is over $600 out of my pocket, (I pay 20% of the cost my insurance pays 80% and no deductible) I plan to simply walk away and pay cash for one online. I do not want to deal with crooks. $300 more than buying it through my insurance is my pain threshold - meaning $900 online vs $600 via my insurance/DME.

They are now a week late calling me to arrange for me to come in and get the machine (I was told 3 to 5 days). I called 2 days ago and they said I would be called within 48 hours to schedule the meeting. This morning was 48 hours. They are treading on thin ice. Another week and I cancel and send a letter to the insurance company and medicare about my dissatisfaction with Humana's ONLY DME Aprea.

The part I found most frustrating was the three months the office manager in my doctors office, the insurance company, and the DME argued over what machine, mask, hose, and cushions I needed without even consulting me. I spoke to all three of them on the phone multiple times until I got blank forms and filled them out myself. I put the same machine and mask I wanted on all the forms and had my doctor sign them. It took another 30 days to get the equipment.

I have a annual max copay that is the same for the year no matter what the insurance ends up paying.

Quote
There's no way you can get involved in a racket and not someway be filthied by it.
- Steve Albini

2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
(This post was last modified: 03-30-2016 05:08 PM by 0rangebear.)
03-30-2016 05:07 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #8
RE: Question about billing/insurance
(03-30-2016 05:07 PM)0rangebear Wrote:  
(03-30-2016 04:38 PM)FrankNichols Wrote:  
(03-30-2016 03:59 PM)0rangebear Wrote:  To give you a comparison
I got the same machine on 12/27 My insurance negotiated $1200 for the month and set up and $170 each month for three months once they had proof of compliance each that month. That's a total $1740 smackaroos. Humidifier headgear tubing and mask with two replacement cushions was included.

Thats bad too, I have heard worse still.

My intention is to get all the numbers up front when I go in and if the total is over $600 out of my pocket, (I pay 20% of the cost my insurance pays 80% and no deductible) I plan to simply walk away and pay cash for one online. I do not want to deal with crooks. $300 more than buying it through my insurance is my pain threshold - meaning $900 online vs $600 via my insurance/DME.

They are now a week late calling me to arrange for me to come in and get the machine (I was told 3 to 5 days). I called 2 days ago and they said I would be called within 48 hours to schedule the meeting. This morning was 48 hours. They are treading on thin ice. Another week and I cancel and send a letter to the insurance company and medicare about my dissatisfaction with Humana's ONLY DME Aprea.

The part I found most frustrating was the three months the office manager in my doctors office, the insurance company, and the DME argued over what machine, mask, hose, and cushions needed without even consulting me. I spoke to all three of them on the phone multiples time until I got blank forms filled them out myself put the same machine and mask I wanted on all the forms and had my doctor sign them. It took another 30 day to get the equipment.

I have a annual max copay that is the same for the year no matter what the insurance ends up paying.

Quote
There's no way you can get involved in a racket and not someway be filthied by it.
- Steve Albini

Bottom line is this is what you get with our healthcare.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
(This post was last modified: 03-30-2016 05:11 PM by FrankNichols.)
03-30-2016 05:08 PM
Find all posts by this user Post Reply Quote this message in a reply
0rangebear Offline

Advisory Members

Posts: 341
Joined: Jan 2016

Machine: ResMed AirSence 10
Mask Type: Other
Mask Make & Model: Amara View
Humidifier: HumidAire (Built-in)
CPAP Pressure: APAP 12.8-15 EPR 3 (cmH2O)
CPAP Software: ResScan SleepyHead

Other Comments: Ramp off

Sex: Male
Location: Brighton Colorado

Post: #9
RE: Question about billing/insurance
If you think it is expensive now just wait until it is freely provided by your government.Dielaughing

2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
(This post was last modified: 03-30-2016 05:16 PM by 0rangebear.)
03-30-2016 05:16 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #10
RE: Question about billing/insurance
(03-30-2016 05:16 PM)0rangebear Wrote:  If you think it is expensive now just wait until it is freely provided by your government.Dielaughing

I edited my post because I originally said "for profit" instead of our. The reason I edited it, was that there are enough sites where we can go to discuss politics, and I prefer to keep this site about Apnea. Sorry, I started this.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
03-30-2016 05:21 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Insurance won't pay for power cord? CharlotteYork 13 885 11-17-2016 11:58 PM
Last Post: tzk321
Sad Help Finding A Machine, No Insurance SJGino 23 766 11-17-2016 09:03 PM
Last Post: SJGino
Angry INSURANCE RECORDS: DO YOU REALLY WANT TO KNOW? srlevine1 5 550 11-15-2016 06:31 PM
Last Post: Galactus
  [CPAP] Insurance / Getting first CPAP rjbbjr 14 620 11-11-2016 01:06 PM
Last Post: Mosquitobait
  Insurance woes: Who has my "compliance" and "post pap" documentation? luminous 8 1,295 08-15-2016 12:09 AM
Last Post: SaldusMiegas
  ASV and Insurance Question rozenbob 15 712 08-06-2016 08:43 PM
Last Post: DeepBreathing
  Will insurance cover ziplock lips? FrankNichols 4 473 05-11-2016 03:05 PM
Last Post: forrestc

Forum Jump:

Who's Online (Complete List)