RE: Problem with insurance
IMHO there are two things going on here, one is relevant and the other is just background.
1. background: Many DME's have been operating for a long time and started out in a high profit time. With Medicare bidding, the profit has been cut drastically and many DME's are having a very hard time staying in business because they are very inefficient. Because of this they are looking for everyway possible to increase revenue/profit. This does NOT make it right, it's just what I think is going on at least mostly.
2. 100% of the time I have had problems with my Doctor or DME, I have called my insurance and asked their help. I understand that your results may vary, but Medicare helps here these days. They have started a "customer experience" rating and if the customers (you) are not happy then Medicare will reduce payments to the insurance company. This has now been around for a while and from what I have seen, they are all watching it closely because it hits the insurance company right in the money.
Gather all your resources to help out. Insurance company, Doctors office (they can also be very helpful also)
as a last note make sure that EVERYTHING you are using is on your prescription: water chamber, hose, everything. You may also look at your medical necessity letter to make sure humidification is included. Oh and sure the parts can be ordered as a separate item, but the CPAP CANNOT be used without them, a good argument that they should not be billed separately
1. background: Many DME's have been operating for a long time and started out in a high profit time. With Medicare bidding, the profit has been cut drastically and many DME's are having a very hard time staying in business because they are very inefficient. Because of this they are looking for everyway possible to increase revenue/profit. This does NOT make it right, it's just what I think is going on at least mostly.
2. 100% of the time I have had problems with my Doctor or DME, I have called my insurance and asked their help. I understand that your results may vary, but Medicare helps here these days. They have started a "customer experience" rating and if the customers (you) are not happy then Medicare will reduce payments to the insurance company. This has now been around for a while and from what I have seen, they are all watching it closely because it hits the insurance company right in the money.
Gather all your resources to help out. Insurance company, Doctors office (they can also be very helpful also)
as a last note make sure that EVERYTHING you are using is on your prescription: water chamber, hose, everything. You may also look at your medical necessity letter to make sure humidification is included. Oh and sure the parts can be ordered as a separate item, but the CPAP CANNOT be used without them, a good argument that they should not be billed separately
