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The Circle of Incompetence
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JohnNJ Offline

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Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #1
The Circle of Incompetence
I'll list the steps. See if you can follow it to it's incompetent conclusion.

1) Sleep doctor sends a prescription for a battery backup to THAT DME.

2) DME calls my house and says it's not covered. "You have to pay $1,100."

3) I ask why. DME says to call Carecentrix, so I call.

4) Carecentrix doesn't have any record of this. Tells me to call Cigna, so I do.

5) Cigna says Carecentrix handles sleep claims and transfers me back to Carecentrix.

*Note: I have to explain the entire history to each new person.

6) Carecentrix says the DME never submitted a claim so she calls DME.

7) DME says yes they did call me and tell me it wasn't covered.

8) Carecentrix asks DME how they came to that conclusion. DME says she doesn't know.

9) Carecentrix tells DME to submit a claim like they should have in the first place.

10) I'm told I should hear from them in a few days. Doubtful.

BTW, Cigna says the battery backup IS covered. Go figure.
04-30-2014 03:31 PM
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PollCat Offline
Apnea Board Polling Administrator
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Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #2
RE: The Circle of Incompetence
DME apparently did not want to be bothered with actually calling the insurance company. You need to find a more reliable, competent, DME. Or better yet, contact the insurance company and see which DMEs they would recommend.


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
04-30-2014 06:43 PM
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SuperSleeper Offline

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Post: #3
RE: The Circle of Incompetence
John, sounds like you're getting the standard "Medical Mafia" run-around. I'd be willing to bet that the DME was trying to extort $$ from you claiming it wasn't covered, and they were hoping you would simply pay the full retail price and they'd get more profit than if they were to submit it to the insurance company whereupon they would receive the lower, insurance-adjusted price for the item. The back-peddling by the DME was just an attempt to cover their tracks.

Like Archangle's signature line goes...

"If it's midnight and a DME tells you it's dark outside, go and check for yourself."

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

04-30-2014 06:49 PM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #4
RE: The Circle of Incompetence
(04-30-2014 06:49 PM)SuperSleeper Wrote:  John, sounds like you're getting the standard "Medical Mafia" run-around. I'd be willing to bet that the DME was trying to extort $$ from you claiming it wasn't covered, and they were hoping you would simply pay the full retail price and they'd get more profit than if they were to submit it to the insurance company whereupon they would receive the lower, insurance-adjusted price for the item. The back-peddling by the DME was just an attempt to cover their tracks.

Like Archangle's signature line goes...

"If it's midnight and a DME tells you it's dark outside, go and check for yourself."

Do you think they actually have such a sinister motive? I never thought about profit as their motivation. I just thought they were dumb, lazy or both.
04-30-2014 07:34 PM
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JWR Offline

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Post: #5
RE: The Circle of Incompetence
Like Archangle's signature line goes...
[i]
"If it's midnight and a DME tells you it's dark outside, go and check for yourself."

Do you think they actually have such a sinister motive? I never thought about profit as their motivation. I just thought they were dumb, lazy or both.



It's All about the Money honey ! Shock-2

04-30-2014 09:01 PM
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Doc J Offline

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Other Comments: Knowledge is King and this is the place to find it! Thanks everyone.

Sex: Male
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Post: #6
RE: The Circle of Incompetence
So what kind of $300 unit are they trying to get $1100 for? I guess if insurance will pay you could go that way. I'm sure I would research and get my own for about what the deductible or copay is. What is medical about a battery backup? A chance for them to make the extra bucks, as you can see you hit a chord with me on this one. I may not get anything else from my DME, what's the quote "screw me once it's .....always their fault" There is such thing as fraud if you want to push it but I would just wave goodbye. Do you have a lot of power outages where your at? I guess I never heard that being prescribed. I'll get off my soapbox and chill out now.
Good Luck.
Doc J
04-30-2014 09:43 PM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #7
RE: The Circle of Incompetence
(04-30-2014 09:43 PM)Doc J Wrote:  So what kind of $300 unit are they trying to get $1100 for? I guess if insurance will pay you could go that way. I'm sure I would research and get my own for about what the deductible or copay is. What is medical about a battery backup? A chance for them to make the extra bucks, as you can see you hit a chord with me on this one. I may not get anything else from my DME, what's the quote "screw me once it's .....always their fault" There is such thing as fraud if you want to push it but I would just wave goodbye. Do you have a lot of power outages where your at? I guess I never heard that being prescribed. I'll get off my soapbox and chill out now.
Good Luck.
Doc J

I'm presuming they're looking at the Resmed Power Station battery but it's listed at around $700 for the kit at one of the listed providers. Don't know how they came up with $1,100.

Cigna said they will cover it like any other medical device so all I pay is 15% of the contracted price. I don't know what that price is but I'm sure it's less than $1,100.

Also, I did ask about better DME's but they could only give me a list of places in my area. They would not say one was better than the others.
05-01-2014 07:34 AM
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c0reDump Offline

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Post: #8
RE: The Circle of Incompetence
(04-30-2014 07:34 PM)JohnNJ Wrote:  Do you think they actually have such a sinister motive? I never thought about profit as their motivation.

Dielaughing

Once the claim goes through your insurance company, pull the "Explanation of Benefits" record for it -- you'll be surprised (I'm guessing the DME will get half of what they are trying to fleece out of you).

(04-30-2014 07:34 PM)JohnNJ Wrote:  I just thought they were dumb, lazy or both.

They wouldn't appear dumb/lazy if the tables were turned: if they'd get more money for actually billing through your insurance company.

Never pay a medical bill until it has gone through the insurance company first, even if you think the claim is 'not covered' (or you haven't met the deductibles yet). Just getting the insurance-negotiated rate is worth a small fortune in and of itself.
05-01-2014 08:05 PM
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PaulaO2 Offline
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Post: #9
RE: The Circle of Incompetence
Ask if they'd let you get it via online and reimburse you. It would be cheaper all around.

Even at $700, that's still a lot.

Supplier #2 has one for $289. The power adapter needed for the S9 is $99.
Supplier #4 has one for $329 and has the adapter for $89.
Several others I checked had similar prices and/or had their own brand for about the same price.

In my opinion, buying the ResMed brand one for $700 when you can get the same thing for half that is a waste of money. If your 15% deductible comes close to either of those, pay out of pocket.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-01-2014 08:26 PM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #10
RE: The Circle of Incompetence
I am SO DONE with that DME!!!
05-02-2014 10:43 AM
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