any attorney or feedback help please medical

[Brumeiser]

We are in a sticky situation and we need either a attorney advice or someone who has gone through this situation. Back in September my cpap machine died and I ended up getting a new machine, our deductible was met so the machine was all paid for (2,000 dollars) in full. The supplier of my cpap had talked to the insurance and it was agreed a new machine was needed and it was to be 100 covered. On November 1, my wife cancelled her insurance at work to end November 30 because I went on my work insurance plan (this occured on November 1st) which was free compared to her 400 a month. The insurance saw she was cancelling the insurance so they denied the cpap machine payment thus we now owe the 2000 dollars since I had no insurance at the time. Can they legally do this? All other bills for October and November so far have been paid by my wife insurance. If they deny a appeal can we legally go after them especailly the 900 dollars a month they (wife and employer) pay for the medical coverage? Or is it to hard to legally go after a insurance company? Help people what can we do?

 

[WDWisTheBest]

We are in a sticky situation and we need either a attorney advice or someone who has gone through this situation. Back in September my cpap machine died and I ended up getting a new machine, our deductible was met so the machine was all paid for (2,000 dollars) in full. The supplier of my cpap had talked to the insurance and it was agreed a new machine was needed and it was to be 100 covered. On November 1, my wife cancelled her insurance at work to end November 30 because I went on my work insurance plan (this occured on November 1st) which was free compared to her 400 a month. The insurance saw she was cancelling the insurance so they denied the cpap machine payment thus we now owe the 2000 dollars since I had no insurance at the time. Can they legally do this? All other bills for October and November so far have been paid by my wife insurance. If they deny a appeal can we legally go after them especailly the 900 dollars a month they (wife and employer) pay for the medical coverage? Or is it to hard to legally go after a insurance company? Help people what can we do?

I would highly suggest that you contact an attorney in the city where you live for advice. Many will talk with you for the first one half hour without charging.

To answer one question: yes it is both hard and expensive to try to sue an insurance company. You may need expert legal advice, but realize that it may cost more to sue than to work out an arrangement through the insurance company.

 

[tlbwriter]

Before you go the attorney route, did you file an appeal with your insurance? Have you contacted your state's insurance commissioner?

 

[AlbertZeroK]

We are in a sticky situation and we need either a attorney advice or someone who has gone through this situation. Back in September my cpap machine died and I ended up getting a new machine, our deductible was met so the machine was all paid for (2,000 dollars) in full. The supplier of my cpap had talked to the insurance and it was agreed a new machine was needed and it was to be 100 covered. On November 1, my wife cancelled her insurance at work to end November 30 because I went on my work insurance plan (this occured on November 1st) which was free compared to her 400 a month. The insurance saw she was cancelling the insurance so they denied the cpap machine payment thus we now owe the 2000 dollars since I had no insurance at the time. Can they legally do this? All other bills for October and November so far have been paid by my wife insurance. If they deny a appeal can we legally go after them especailly the 900 dollars a month they (wife and employer) pay for the medical coverage? Or is it to hard to legally go after a insurance company? Help people what can we do?

My understanding is that you were insured when you got the CPAP correct? Then it's not an issue, the problem you have is like the one I had a few years ago, the insurance company is stupid or the people on the phone is stupid.

How I fixed the issue for me was to go through my employeer who turned it over to HR. Our HR Rep got a hold of a rep at the insurance company - when I got to the right people, ALL my problems were solved.

I'm not sure how to get you to the right place, but I'd stop calling customer service and start calling their cooperate office asking for the VP of customer relations or something like that. Also, if your state has an agency that oversees insurance, you might start their.

I have a feeling once you get to the right people, you'll be fine and won't need to litigate, if you do, it will be cheaper to pay the $2,000 than to litigate - and I'd talk with the CPAP guys, a CPAP is CHEAP, about $500 or less (http://www.cpap.com) so their is alot of mark up, they may be happy settling for less than $2,000 - but I'd use that as a last resort.

And of course, I could be wrong on all of this.

 

[lost*in*cyberspace]

I have a feeling once you get to the right people, you'll be fine and won't need to litigate, if you do, it will be cheaper to pay the $2,000 than to litigate

Absolutely true about it being cheaper to pay the $2,000 than to litigate. Do whatever you can to work this out yourself without becoming involved in the legal system.

 

[DominicaAnne]

Almost exactly the same thing happened with my husband's first c-pap, switched insurance companies and the new company refused to pay for the c-pap, but the medical supply place didn't send us a bill until 6 months later, so it was for thousands of dollars. Turns out that the insurance company didn't purchase the c-pap, they leased it, so the medical supply place sent us a bill for the total leasing amount. my husband called the medical supply place and freaked out on them for sending us a huge bill so many months later, and we ended up just purchasing the c-pap from them and not owing the lease.

My advice is to call the place that provided the c-pap ASAP and find out what the deal is. A PP was right, c-paps are actually more in the $500 or less range to purchase outright. It sounds like your insurance company also had a lease contract that is now being passed off to you. Don't let this happen! Give the thing back to them and buy a new one outright if you have to. We just bought a really nice unit over the summer for about $400 (including the nose mask). It is very small and lightweight and has the water reservoir that keeps DH's sinuses from drying out.

ETA that the old insurance company refused the bill, and then the new company wouldn't pay it either.

 

[tinker&belle]

When you talk to your insurance as for a case manager. This should help you get to the right people.

 

[WDWisTheBest]

Almost exactly the same thing happened with my husband's first c-pap, switched insurance companies and the new company refused to pay for the c-pap, but the medical supply place didn't send us a bill until 6 months later, so it was for thousands of dollars. Turns out that the insurance company didn't purchase the c-pap, they leased it, so the medical supply place sent us a bill for the total leasing amount. my husband called the medical supply place and freaked out on them for sending us a huge bill so many months later, and we ended up just purchasing the c-pap from them and not owing the lease.

My advice is to call the place that provided the c-pap ASAP and find out what the deal is. A PP was right, c-paps are actually more in the $500 or less range to purchase outright. It sounds like your insurance company also had a lease contract that is now being passed off to you. Don't let this happen! Give the thing back to them and buy a new one outright if you have to. We just bought a really nice unit over the summer for about $400 (including the nose mask). It is very small and lightweight and has the water reservoir that keeps DH's sinuses from drying out.

ETA that the old insurance company refused the bill, and then the new company wouldn't pay it either.

Helpful information for the OP.

 

[Brumeiser]

My wife got smart and decided to call the home patient place and boy we are impressed with this place. Yes they agree that they got the notice to bill it as a purchase, and it was to be completely covered at 100 percent. They keep excellent track of their calls. On November 17 they were contacted about billing it as a monthly rental instead of purchase and they told them no they can not rebill it. The patient place feels like they changed their mind to go monthly that they would be only responsible for 1 month rental and the insurance would be out of paying for the whole thing. Anyhow they are now contacting the State Attorney Office of our state and they are going after the insurance company for them to pay. The home patient believes it is not our responsiblity since they had confirmation that it was 100 percent covered, so they will take care of it. So we will just sit back and let these 2 companies fight it out. All I can say now is, that this place will have my business for life.

 

[DominicaAnne]

That is GREAT news! Glad that the supply place decided to look into it, and came to their own conclusion that the insurance company was being shady. Hope this works out for you

 

[AlbertZeroK]

They'd earn my buisness too! Amazing!

 

[tweedlemom]

Great news!

 

[C.Ann]

Hopefully this is now going to be a happy ending.. Great news!

 

[eeyore81]

Great news! Just a bit of advice. Don't just sit back and let them work it out. I would call every couple of weeks to find out the status. Also, make sure your time to appeal the denial, etc does not run out while you are waiting for them to work it out. People sit back thinking things are getting taken care of and then when the bill goes to collections or something like that I always hear the excuse of "I thought it was all taken care of". Hopefully it will all work out.