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+--- Thread: Here to vent (/Thread-Here-to-vent)
Here to vent - Razorpoke - 04-16-2024
Like many people, I have a high deductible plan ($4k) but I contribute to a HSA and my employer also adds $1k. I just got absolute sticker shock (except it's not a sticker, it's real bills) after a recent in home sleep study.
I understand how these plans work and I certainly expected to pay something. Perhaps I should have even asked for estimates, that's on me.
But the real kick in the pants is that my new PCP sent me to a pulmoligist (we recently relocated so I told my new PCP about my apnea and the last time I was studied, which was 2018).
Pulmologist ask me a few questions, listens to my heart and lungs and says, yep better get a new study. And here is a $189 bill for me telling you so.
Then I go through the denial process, which I had already experienced in 2018 but I let it play out. Aetna won't pay for a lab study, just a home study. Ok, whatever. I go in and get the unit and the instructions. Take it back the next day on time and await what I already know -- yep, you have apnea and need a CPAP.
So, now I get the bill(s). One is coded as a HOME SLEEP TEST/TYPE III POR, $1,698 discount of 339.60 leaving me and my HSA to pay $1,358.40. Turns out that is for Dr. Pulmologist to "read" the study.
Get another billl from the lab. It is coded as a HOME SLEEP TEST/TYPE III POR, $1,698 discount of $1,156.34 leaving me and my HSA (mostly now depleted) to pay $541.66.
EOB's agreeed with all the above data. So, I call Aetna, tell them that it looks like some double dipping is going on here. But, no, it's all legit. I happily agree but push a little further as to why the discounts for the same code is different. Answer, some providers negotiated different rates. The sleep lab is in the same hospital, same floor and steps away from the pulmologist!!!!!!! How can the negotiated rate be different!!!!???
I've never put my finger on it, but all 3 studies I've done to date and then the supply people -- the whole thing just feels sleazy and scammy and like a money grab.
I'm waiting on the supply people to call, but my intention is to tell them that my machine is currently working fine and I'm not interested in another. They can provide the supplies ( I'm currently still getting from a supplier a thousand miles away).
Sorry, I'm worked up about this. The whole medical / insurance thing in this country seems so screwed up and unfair. I just can't see $2.900 worth of services here, yet I feel helpless about the whole thing.
RE: Here to vent - Nightynite - 04-16-2024
Yep, I even called Medicare to complain about my situation with my useless DME. I was just starting out and they weren’t concerned either, they just agreed with me and said have a nice day.
RE: Here to vent - sauerkraut - 04-16-2024
I agree with You sure looks like a money grabbing good'ol boys club !!
I've said for years the two worst thinks that have happened to the country
are Insurance Companies and Lawyers ..
RE: Here to vent - car54 - 04-16-2024
and politicians
RE: Here to vent - Gideon - 04-16-2024
Post your sleep tests rresults here. ust to make sure you get the right machine.
RE: Here to vent - sauerkraut - 04-17-2024
car54;
The vast majority of politicians are lawyers ..
RE: Here to vent - Sleeprider - 04-17-2024
The real shame is that you could have gotten a home study with physician review and prescription for under $300 and bought a new Resmed Airsense 10 Autoset card to cloud for $459, and gotten some good discounts on that total. I wish people would start here on Apnea Board before getting ripped off.