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Help me understand. Switched insurance and now completely confused!
I just switched from Arizona's state funded insurance to employer insurance. (Got a job and making too much to stay on government health care) So all the sudden I get an insurance claim from my CPAP supplier for $175.00, then another, then another, So, I finally get a hold of them to ask what the world is going on, and come to find out I am RENTING my machine from them. Why didn't the insurance I was on first pay for it in full? I asked them if the other insurance hadn't covered any of it and they said "We start over with the balance when you switch insurances" So now I have to pay $175 a month for 13 months for my machine. Is that common? Is there a better option? Can't I just pay for it in full and get it over with? I detest "payment plans". I would much rather get it done and never worry about it again. I'm new to the insurance thing because up until now I've had an awesome insurance that covered 100%. If I have to pay for this thing all over again, I'm just going to tell them they can have it back. I'll lose more sleep stressing than I will not breathing.
Views: 65
Replies to This Discussion
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Permalink Reply by Mary Z on
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If you can buy the machine on line for less than $2000 I'd say do that. What kind of machine do you have?
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Permalink Reply by Judy on
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Most insuranceS "rent to own" for various lengths of time. With Medicare it is 13 months and many insurances follow that path. Other insurances rent to own from 3 to 10 months. It varies.
I would contact the state licensing bureau and my new insurance about this "starting all over again" bit, tho. I fail to see where it would be legal for a business to charge 13 months of a "capped rental" for a now USED device. If they want to collect another 13 months "capped rental" after having received several months already, let them provide you w/a BRAND NEW CPAP. And an upgrade to a more sophisticated CPAP. For instance, from a bare-bone, entry-level, compliance data only CPAP to a fully data capable CPAP or from a fully data capable CPAP to a fully data capable APAP. Or if your current CPAP is a Resmed S8 or a Respironics M Series upgrade you to a fully data capable Resmed S9 or fully data capable PR SystemOne.
If you have the financial wherewithall to buy your CPAP outright, return their CPAP and buy a brand new one (considerably cheaper) from an online supplier like cpap.com. You get more for less from them and the staff is very helpful in answering questions. You WILL need a copy of your equipment order (script) to buy online but that shouldn't be a problem to get one from your sleep doctor or even your family doctor. Your script is part of your medical records and as such you have a LEGAL RIGHT to a copy under HIPAA.
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Many insurers follow Medicare guidelines which require the machine (not the humidifier or supplies like hoses, filters, and masks) to be purchased on a "capped rental" basis (rent for 13 months, then it's yours), but I think the "starting over" sounds fishy, too. You need to call your new insurance provider and see what their policy is on things like this. You should also find out:
1. Do they require capped rentals or pay for purchased machines?
2. How do they reimburse? Usually it's by HCPC's code (billing code) which is the same for ALL CPAP/APAP machines, meaning that they don't restrict you to a low end model (but the DME may try to convince you otherwise).
3. What are your out of pocket expenses going to be for co-pays and deductibles?
4. What DME providers are covered under your new plan?
Beware that some insurers only cover eqipment with specific DME providers, and if the DME provider you have been using is not one of your new insurer's providers you could be paying the whole thing out of pocket. If that's the case, return the rental and use a provider covered by your new insurance plan.
Don't forget to compare your out of pocket costs (keeping in mind that you may have a new deductible every calendar year) and the online costs. Since you already have a humidifier, hoses, filters, etc, it may be MUCH less expensive to simply replace the machine with a new one of the same model online than to pay the out of pocket costs with your new insurer.
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Permalink Reply by RChatty on
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Either I'm really unintelligent, or something, but I don't know exactly what machine I have. It says Respironics System One RemSTAR on it, but it doesn't say PRO or PLUS or anything like that. It has a humidifier with it, and also an sd card. Maybe all you intelligent people will know which one I have.
Thanks for the tips. I thought it sounded rather fishy, but I live in the sea (in Arizona Ü) and everything sounds fishy to me so I didn't know if it was just me. I'm not sure how to go about it because it takes an act of congress to get a hold of them.
The provider is covered under my insurance, I checked that out first thing. Thanks Janknitz for the list. I'll find those out too. Anything anyone tells me about dealing with my own insurance is helpful since I'm new at this game.
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Permalink Reply by sleepycarol on
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I am unsure how it works in your state -- but in Missouri our Medicaid program doesn't reimburse very much on claims. So it may be "awesome" insurance to you at very little cost out of pocket -- but ultimately someone is paying the bills. I know most doctors around here have stopped seeing patients with Medicaid due to the low reimbursements rates that they have to accept if the take Medicaid patients.
Our family doctor does not take Medicaid patients due to the above. We have used the same doctor since my daughter was born (approximately 25 years). My daughter is temporarily receiving Medicaid at this time. Our doctor was kind enough to see her and charge her what Medicaid would have reimbursed her -- believe me it wasn't enough to pay the doctor's overhead for that visit let alone make a profit.
It may be (although I am not advocating that it is right) that the DME may feel that since they provided the machine and probably was not reimbursed at the "going" rate they are "due" more money.
How long have you had the machine? Has it been over a year? Has it been only a couple of months? If you have had the machine for any length of time, try to negotiate with the DME about the charges.
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Permalink Reply by 99 on
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there should be the word auto
Respironics System One RemSTAR auto
in the name the auto tells us that it is fully data capable
RChatty said:Either I'm really unintelligent, or something, but I don't know exactly what machine I have. It says Respironics System One RemSTAR on it, but it doesn't say PRO or PLUS or anything like that. It has a humidifier with it, and also an sd card. Maybe all you intelligent people will know which one I have.
Thanks for the tips. I thought it sounded rather fishy, but I live in the sea (in Arizona Ü) and everything sounds fishy to me so I didn't know if it was just me. I'm not sure how to go about it because it takes an act of congress to get a hold of them.
The provider is covered under my insurance, I checked that out first thing. Thanks Janknitz for the list. I'll find those out too. Anything anyone tells me about dealing with my own insurance is helpful since I'm new at this game.
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It should say right above the LED screen window, i.e. "REMstar Auto A-Flex"
RChatty said:Either I'm really unintelligent, or something, but I don't know exactly what machine I have. It says Respironics System One RemSTAR on it, but it doesn't say PRO or PLUS or anything like that. It has a humidifier with it, and also an sd card. Maybe all you intelligent people will know which one I have.
Thanks for the tips. I thought it sounded rather fishy, but I live in the sea (in Arizona Ü) and everything sounds fishy to me so I didn't know if it was just me. I'm not sure how to go about it because it takes an act of congress to get a hold of them.
The provider is covered under my insurance, I checked that out first thing. Thanks Janknitz for the list. I'll find those out too. Anything anyone tells me about dealing with my own insurance is helpful since I'm new at this game.
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