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Cpap provider overbilling insurance Company - mrkurtz - 11-15-2017
I just got my first bill from my CPAP provider, a respiratory care branch of the hospital I go to.
The bill was completely covered by my insurance company, which was good news.
In looking over the bill, I saw that they were charging for my machine , a Resmed Airsense 10, and additionally, for the heated humidifier, which is actually part of the machine. I don't think Resmed offers a machine without the humidifier section.
So $140 a month for the CPAP, another $40 for the "Heated humidifier", comes to $180.00 a month rental. That is $1800.00 for ten months.
Online, these machines cost around $800.00.
It seems to me, that these respiratory suppliers, are ripping off the insurance companies, which results in the medical/insurance crisis, we are all facing.
I'm lucky my insurance is paying for all this, but I feel like an accomplice in this apparent overcharging-rip-off scheme.
Am I missing something?
According to my math, in 5 years, if I keep the machine that long, the machine I could buy outright for $800.00 will end up costing mu insurance company $10,800.00
This seems wrong.
RE: Cpap provider overbilling insurance Company - Walla Walla - 11-15-2017
Welcome to the world of CPAP.
RE: Cpap provider overbilling insurance Company - phrogpilot73 - 11-15-2017
My insurance is "renting to own" my CPAP. To the tune of $150/month. For 15 months.
Yup, $800 dollar machine is costing my insurance $2250. At least I'll own it after that...
RE: Cpap provider overbilling insurance Company - Walla Walla - 11-15-2017
The practice of billing for the humidifier separately and also the hose is normal. Most insurance companies follow Medicares lead on what they pay. Medicare approves the separate charges and so that's how the system works. Blame the government for letting themselves or I should say all of us for getting ripped off.
RE: Cpap provider overbilling insurance Company - TASmart - 11-15-2017
But the DME is also obligated to provide RT support if you have issues. But from my experience, that is not worth much. I suspect the length of the rental period is strongly related to the warranty and the mean time to failure.
RE: Cpap provider overbilling insurance Company - trish6hundred - 11-15-2017
Hi mrkurtz,
WELCOME! to the forum.!
Unfortunately, this is a fairly common occurrence.
Good luck with CPAP therapy, hang in there for more responses to your post.
RE: Cpap provider overbilling insurance Company - fishkeg - 11-15-2017
Its the same here in Canada. My Sleep clinic wanted to charge me nearly $2500, my insurance would cover only $1500 of that. Thankfully I found the exact same machine online for $750, which was covered 100% by insurance.
RE: Cpap provider overbilling insurance Company - Sleeprider - 11-16-2017
Most providers are under contract to sell or rent equipment at a discounted price you may never see. It is typical for them to invoice at far higher prices than will be approved by the insurer. The actual price allowed is a big secret individually negotiated between suppliers and insurers. This is not only legal, but expected behavior among medical equipment, pharmacy and service providers. No only that, but rules exist to prohibit them from billing different classes of consumer (insured and uninsured) differently, so uninsured patients without a negotiated "secret" price get stuck owing the invoice price. It's a screwed up system for sure.
RE: Cpap provider overbilling insurance Company - fishkeg - 11-16-2017
It's a shame that aspects of human healthcare are more about profit than actual patient care.
RE: Cpap provider overbilling insurance Company - Sleeprider - 11-16-2017
Medicine is big business. There are still people who care, but they have money businessmanagers, billing assistants, insurance specialists, and most are in corporate practices and have no say regarding the business aspects of medicine. My dad was a pediatrician from the old days of private practices, house-calls and accepting chickens, dogs and shoes in lieu of cash for services. I can tell you about it sometime. He used to have a telephone in his bedroom where he took calls in the morning. We grew up learning how to answer that phone, "Dr. xxx's residence".
I took it all in stride until I became a teenager and had my first date with a girl who shyly told me, "your dad has seen me naked". Wow! Mind blown!