Gap exception

Do you live in the wilderness and you can't find a DME fer beans?? I might have a suggestion. I just confirmed with my insurance company that I can order my own machine and supplies on the internet and they'll reimburse me as if it were "In Network". Less over all cost to everyone including the insurer and less co-pay by 10%. Yahoo!! Anything over 30 miles from my zip code and they call it a "gap" in their coverage area. An exception is made. I have to get a firm quote with all the insurance billing numbers, etc., and submit it all by phone, but then I'll order. With any luck they'll get me reimbursed before the credit card cycles.

This is a giant step for me!!! 3 DME's have failed to see that my machine isn't registering that I'm breathing. The fact that I got the Encore software isn't doing too much to help me monitor my therapy!!! Hope it all works!!!

Kelvin

AND ...they'll replace my machine every 3 years!! It was a great phone call!!!

kwikwater wrote:Do you live in the wilderness and you can't find a DME fer beans?? I might have a suggestion. I just confirmed with my insurance company that I can order my own machine and supplies on the internet and they'll reimburse me as if it were "In Network". Less over all cost to everyone including the insurer and less co-pay by 10%. Yahoo!! Anything over 30 miles from my zip code and they call it a "gap" in their coverage area. An exception is made. I have to get a firm quote with all the insurance billing numbers, etc., and submit it all by phone, but then I'll order. With any luck they'll get me reimbursed before the credit card cycles.

This is a giant step for me!!! 3 DME's have failed to see that my machine isn't registering that I'm breathing. The fact that I got the Encore software isn't doing too much to help me monitor my therapy!!! Hope it all works!!!

Kelvin

AND ...they'll replace my machine every 3 years!! It was a great phone call!!!

Good for you. Here's what I did. (somewhat like your situation)

I got pre-authorization from my insurance provider to purchase from CPAP.COM and submit for reimbursement. My insurance provider considered ME to be "in-network". What I then did was to make out an invoice with me as the billing party and my insurance provider being the party being billed. They reimbursed me for 80% of my invoice (less the software and card reader). Most insurance providers consider their members/insured as "in-network" and have provisions (forms) for reimbursing them for out-of-pocket expenses. My wife also used this scenario for submitting her bills from her chiropractor......(although we never reached the deductible limit).


Den

I always try to talk to my insurance before I get new equipment like this the first time or have procedures. I have learned a lot donig this and saved myself time and money. By doing this my insurance company also told me they wouldn't cover or repair two machines if I had one for home and one for the firehouse, but the woman I spoke with said to buy the same exact machine and it would be covered by them for repairs because they woulnd't know any better.

Gerry