Interesting DME Experience

[sansnap]

I need to replace my old 560P and after lots of waffling about what machine to get I decided on the ResMed Autosense10.  My provider does not carry this machine but provided me with a prescription so I could purchase elsewhere.  I arranged to get one from Performance Home Medical; a local DME, and after they checked with my insurance company, they ordered the gear and today I had an appt to pick it up.  

When I arrived I was surprised to learn that they would req that I authorize and auto withdrawal from my bank to cover and co-pays.  When I refused and offered to pay the co-pays and any deductible in advance they said "sure that's fine but we still req. the autopay authorization'.    

I took my prescription home and ordered online from supplier number 33 (who had a sale going) and expect to get the new machine in a few days, then will have to go through the paperwork of getting reimbursed from my insurance company.  

Is this autopay arrangement common?

[Big Guy]

For the DME, maybe. I don't authorize auto pay for anything. 

You did the right thing by doing what you did. 

[Sleeprider]

Autopay has been abused by many DME providers. You agree to pay for your copay and deductibles for covered equipment. There is no reason to sign over an open billing agreement. Supplier #33 will provide the best price available, but may be reimbursed as out-of-network by insurance. i think you did fine however the company's web page makes no mention of requiring a credit card or auto-debit. You should call and speak with a manager about your experience and that was the reason for you decision not to use PHM.

Most insurance companies have a pre-determined allowable for each service rendered by our company, your physician, the hospital and any other service providers. All service providers who bill services to an insurance company bill at usual and customary and then your insurance applies their allowable to the claim. At that point your actual out-of-pocket cost is determined and upon receipt of payment from your insurance, we then bill you for your portion. Unfortunately, insurance claims processing may be delayed which could delay the receipt of your billing from us. We recommend that you set aside your estimated out-of-pocket cost each month until your billing is received.

[SarcasticDave94]

IMO you did the right thing, especially for your own sanity. There's a few horror stories about that things like billing errors funneling monies out of ones own account, and it taking many months to get the funds back. Personally, no DME will get my card or account numbers. If they're claiming it's required, exit stage right pronto.

[Fats Drywaller]

+1 on having done the right thing by severing all ties with that DME. Absolutely. That sounds to me like some sleazy, money-grubbing behavior on the DME's part.

Did your insurance company authorize a machine purchase from any supplier of your choice? In other words, are you sure that it's OK (bureaucratically speaking) to submit that claim for reimbursement and that it will be paid? I thought insurers generally frown on that sort of thing and want the patients to buy only from pre-approved vendors.

[sansnap]

+1 on having done the right thing by severing all ties with that DME.  Absolutely.  That sounds to me like some sleazy, money-grubbing behavior on the DME's part.

Did your insurance company authorize a machine purchase from any supplier of your choice?  In other words, are you sure that it's OK (bureaucratically speaking) to submit that claim for reimbursement and that it will be paid?  I thought insurers generally frown on that sort of thing and want the patients to buy only from pre-approved vendors.

I contacted them and as noted earlier the purchase would be out of network but given the much lower price (local DME would charge Insurance  Co 3X what I paid) the portion that I will have to pay after the dust settles is actually a few dollars less. 

It's maddening that a relatively straightforward purchase should be so difficult and that costs are so much higher to insurance co from the local DME.  At the end of the day we consumers pay for all that bloat in higher insurance fees.

[Fats Drywaller]

It's maddening that a relatively straightforward purchase should be so difficult and that costs are so much higher to insurance co from the local DME.  At the end of the day we consumers pay for all that bloat in higher insurance fees.

A-greed! And the greed seems to be mainly on the part of the local DME company. Even the ones that are relatively straight dealers use huge markups, because that's how the system works at the moment.

The insurers are complicit at the highest levels even if a few of their representatives at the bottom level who deal with patients are more human about it and don't like the cost inflation. An interesting article that I've recommended before: "Why your health insurer doesn't care about your big bills" at the Pro Publica nonprofit org.

I've been thinking lately that it'll be very good for patients, a huge relief, if and when the insurers eventually wise up and start routinely approving out-of-network purchases of medical equipment & supplies, so the patients can shop anywhere, mainly online. But I ain't gonna hold my breath waitin' for that day.

As for the auto-pay scam, I'm disappointed but I guess not surprised to learn that DMEs are using that. It's a sleazy tactic that has been a favorite of various telecom craporations for decades, ever since the 1996 de-regulation. Once the victim's bank information or card information is on file, the telecom company doesn't care if the victim gets angry and cancels due to bad service & high prices. The custservdroid at the call center in India will just shrug and say "That's OK; the billing department has got your number" and the auto-debits will continue every month until the victim closes that bank account or card account. Multiply that by however many million angry customers per corporation, and it becomes a very profitable scam.

[sansnap]

Just got the phone with my ins (Fed Blue Cross) and thought I'd pass this along in case anyone else finds them self in the same position.

They will cover the cost of this machine as follows:

Out of network provider - 55% of plan allowance. If it had been an in network provider it would have been 85% of plan allowance. I paid $610.00 for machine w/some extra filters and a data card (Out of network). I cannot determine what the plan allowance but the smarmy DME I walked out on said they would bill my ins company for the full 1400.00 of the machine and that if I was not compliant I would be on the hook for the charges.

55% of 1400.00 is more than I paid so somehow I think the fine print is going to win in the end but it will be interesting to see how this is resolved.

[Sleeprider]

Your DME would likely bill separately for the CPAP, humidifier, tubing and mask. The amount they would charge could be the sun and the moon, but because they are in-network, they have a contract to provide these at a preset negotiated price. Those prices are confidential, so you will never know, but I would guess it is between $900 to $1200, and this is the basis for your actual copay. In this case the insurance company probably wins, but you reduced the aggravation level, not to mention potential follow-ups you don't need, from a provider you don't like.

I still think you would be well-served by calling Performance Medical and talking to a manager about your dissatisfaction, and especially the representation you would have to leave a debit authorization, rather than pay from an invoice billing. Their website clearly says you will be billed, not debited.

[sansnap]

Yes, I called their corporate office in Kent WA and spoke with "a supervisor". I was assured that this was Performance Home Medicals policy and has been for a year or so. Basically take it or leave it. Today I contacted Fed Blue Cross and got the paperwork to file a complaint about this both with Federal Blue Cross and OPM who negotiate these contracts. It'll likely go nowhere but as a consumer i want my insurance company to be thrifty - they are after all spending my premiums and should be good stewards of my funds. If nothing else I'll feel a little better for having tried