Insurance Fraud? Airsense 10 and ROTECH.

Advantage plans are classified as Medicare type C.
FYI: the C stands for CRAP.

You know, I am thinking about this. If the Supplier is having me sign a contract with them, then my Advantage plan DOES NOT HAVE A BINDING CONTRACT.

You bring up an interesting point that I've NEVER understood. The actual contract you have with your insurer is called an Evidence of Coverage (EOC). But NOBODY sees this before signing on, unless they know to ask for it, and unless they are prepared to understand it. Often terms are obfuscated, for example Kaiser's non-Advantage ACA plains claim to pay for "base" DME, but when you delve into it, almost all they will pay for are canes and crutches. No wheelchairs, no hospital beds, no bedside commodes, no CPAP or supplies, no home oxygen. In other words, none of the things most people might need going home from the hospital.

If your insurance automatically renews on an annual basis, they can change the terms without telling you. And if you get insurance from your employer, you may not even see anything about the plan if it's the only one offered.

A contract, in legal terms, requires a "meeting of the minds"--an agreement and consideration (giving something in exchange for goods or services provided--typically money). But very few purchasers of medical insurance even see the EOC/contract, so how is there a "meeting of the minds"???? Typically, before signing on to medical insurance, you might see an advertising flyer or summary of benefits which is not a contract. Most people have no clue what they are signing up for. But they will be held to its terms even so.

It does work both ways. Insurers are bound by the EOC as well. I once helped a family whose son committed suicide. But he didn't die right away, and the insurer refused to pay the 10 day ICU bill because "it was a self-inflicted injury". However, the EOC had NO exclusion for self-inflicted injuries, and when we pointed it out, they paid up, but only after arguing "most of our plans have that exclusion". This one did not, fortunately for the family who was devastated by the death and then they were handed a bill over $150K.

But I still don't understand how/why insurers get away without providing the EOC automatically when people are going to purchase medical insurance.

And don't forget about the frauds committed by and against Medicare. Those are everywhere now. Just took a look at this list made by a law firm. It's scary.

This is a common issue with DME providers inflating the replacement value in their "Patient Responsibility" forms to cover lost rental income, not just the hardware cost. Under Florida’s Deceptive and Unfair Trade Practices Act, you have grounds to contest that valuation, especially since the MSRP on the 10 series dropped significantly after the Airsense 11 launched.

To avoid the billing loop, I switched over to HealthSQ for my sleep apnea supplies and the transition was much smoother regarding the Medicare coding. Your best move is to contact the Centers for Medicare & Medicaid Services (CMS) and report the discrepancy while looking for a provider that uses standard market rates. You can read more info on https://www.jdsupra.com/legalnews/choos ... r-7089694/

Hmm I don’t know anything about rotech but I know that me having disabilities and my insurance Medicare/Medicade has covered the cost of all my cpap stuff with out me having to pay anything so far. I believe that it would stay this way as long as I show compliance at least 6 hours or more of use a night and that I am benefiting from it. I go to doctor for sleep apnea Dr Olafsson once every year.