Billing issue /question

[bipaptocpap]

I recently was prescribed a CPAP machine. Through my insurance there was an agreement that I pay an upfront cost and then pay smaller monthly payments until the CPAP machine was paid off. Yesterday I received a bill for almost the cost of the upfront payment. Needless to say I was shocked and confused. I feel like I am paying double. I have yet to call the provider (today being Thanksgiving) but I'm afraid they will somehow justify the billing. I'll know more tomorrow but I wanted to share here. I'm sure members here have had similar experiences.

[Pugsy]

So what insurance do you have? Are there deductibles involved?

I assume you are in shock because you got what you thought would be the small monthly bill since you have already paid the upfront cost?
Is that correct?

How much was the bill? Is this the portion that was billed to insurance and insurance has yet to pay or the portion that is your portion after insurance has paid?

Who is your equipment provider?

[greatunclebill]

You have to call your insurance company with this kind of question. they are the only ones that can answer this question.

[bipaptocpap]

So what insurance do you have? Are there deductibles involved?

I assume you are in shock because you got what you thought would be the small monthly bill since you have already paid the upfront cost?
Is that correct?

How much was the bill? Is this the portion that was billed to insurance and insurance has yet to pay or the portion that is your portion after insurance has paid?

Who is your equipment provider?

The bill says the insurance has been applied. A closer look at the itemized bill has charges for the humidifier, tubing , filters , mask, and headgear. The CPAP has a charge as well.

[Pugsy]

Who is your insurance with?

Is this the first bill?

It is common for the humidifier to be billed out up front in full as well as mask and hose since they are considered to be non returnable in most situations.
Then the remaining monthly payments are usually for the blower unit.

I am going on Medicare billing commonalities here...as most insurance will pay like Medicare pays.
Medicare does a rent to own...13 months.

So it's common to have a rather larger bill the first bill and the remaining monthly bills are smaller.
If you don't have Medicare...you are going to need to check with your insurance company as to how they work.
The reason I asked about who your equipment provider was...is because some of them are well known to bill incorrectly.
Don't ever trust the supplier...go directly to your insurance company with questions.

I know Medicare but if your insurance is something else then they might do things differently.

[bipaptocpap]

Who is your insurance with?

Is this the first bill?

It is common for the humidifier to be billed out up front in full as well as mask and hose since they are considered to be non returnable in most situations.
Then the remaining monthly payments are usually for the blower unit.

I am going on Medicare billing commonalities here...as most insurance will pay like Medicare pays.
Medicare does a rent to own...13 months.

So it's common to have a rather larger bill the first bill and the remaining monthly bills are smaller.
If you don't have Medicare...you are going to need to check with your insurance company as to how they work.
The reason I asked about who your equipment provider was...is because some of them are well known to bill incorrectly.
Don't ever trust the supplier...go directly to your insurance company with questions.

I know Medicare but if your insurance is something else then they might do things differently.

UHC, but that is changing at the beginning of next year.

It looks like I haven't met the deductible. Everything checks out with insurance against the provider bill except the charge for the humidifier I can't find. The amount owed insurance says I owe is more than what I was billed.

[Chris8243]

Just a heads up on changing your insurance at the beginning of the year (as you said you were)....they may start all the payments from scratch. I didn’t have an upfront cost for the machine, but with my insurance I was going to pay over 13 months. Got my machine 3 yrs ago in October, changed insurance Feb 1st (went from group insurance at work to private pay when I stopped working). Well, I found out that with a new insurance policy - even with the same company (Blue Cross Blue Shield) - the first few months that I paid “didn’t count” as far as paying over 13 months total. I ended up paying 17 months. I didn’t know this until after my 13th payment and kept getting more bills from the DME and the insurance company was still paying them also.

I was furious! I talked to the insurance company, and yes, even though they made the first few payments also, they were indeed processing the claims as if I had just gotten the machine. Yes, they made payments too (their covered portion) and yes, they knew they were paying more to the DME, but that is what they do. Yes, they understood they were overpaying but it is correct. I called the insurance company several times over several weeks, getting a new person to talk to each time (on purpose) explained the situation and they all told me the same thing!

Then I called the owner of the DME (private company, not big corporation) and calmly told him he was ripping me off. That I had met my end of the bargain (13 payments) and they were still charging me. He listened and then explained just what the insurance company had already told me. That’s the way the cookie crumbles.

Done with my rant. Remembering this from 3 yrs ago gets me all riled up again!

Needless to say I immediately stopped buying my supplies from them.

[chunkyfrog]

Nobody can convince me that there are no kickbacks.
This the deplorable that is least likely to be stopped.
We just have to get smart enough to play at a crooked table, and not lose our shirt.

[bipaptocpap]

Just a heads up on changing your insurance at the beginning of the year (as you said you were)....they may start all the payments from scratch. I didn’t have an upfront cost for the machine, but with my insurance I was going to pay over 13 months. Got my machine 3 yrs ago in October, changed insurance Feb 1st (went from group insurance at work to private pay when I stopped working). Well, I found out that with a new insurance policy - even with the same company (Blue Cross Blue Shield) - the first few months that I paid “didn’t count” as far as paying over 13 months total. I ended up paying 17 months. I didn’t know this until after my 13th payment and kept getting more bills from the DME and the insurance company was still paying them also.

I was furious! I talked to the insurance company, and yes, even though they made the first few payments also, they were indeed processing the claims as if I had just gotten the machine. Yes, they made payments too (their covered portion) and yes, they knew they were paying more to the DME, but that is what they do. Yes, they understood they were overpaying but it is correct. I called the insurance company several times over several weeks, getting a new person to talk to each time (on purpose) explained the situation and they all told me the same thing!

Then I called the owner of the DME (private company, not big corporation) and calmly told him he was ripping me off. That I had met my end of the bargain (13 payments) and they were still charging me. He listened and then explained just what the insurance company had already told me. That’s the way the cookie crumbles.

Done with my rant. Remembering this from 3 yrs ago gets me all riled up again!

Needless to say I immediately stopped buying my supplies from them.

Thanks for your reply...I will definitely see what happens.

[bipaptocpap]

Nobody can convince me that there are no kickbacks.
This the deplorable that is least likely to be stopped.
We just have to get smart enough to play at a crooked table, and not lose our shirt.

If only we had free-market health insurance....

[chunkyfrog]

Nobody can convince me that there are no kickbacks.
This the deplorable that is least likely to be stopped.
We just have two get smart enough to play at a crooked table, and not lose our shirt.

If only we had free-market health insurance....

TRANSPARENCY is needed, and accountability--not the mad house of secrecy and skulduggery we have now.
PS--you changed my "to" to a "two".
DO NOT alter quoted passages--it is dishonest.

[zonker]

Nobody can convince me that there are no kickbacks.
This the deplorable that is least likely to be stopped.
We just have two get smart enough to play at a crooked table, and not lose our shirt.

If only we had free-market health insurance....

TRANSPARENCY is needed, and accountability--not the mad house of secrecy and skulduggery we have now.
PS--you changed my "to" to a "two".
DO NOT alter quoted passages--it is dishonest.

"skulduggery", indeed!