Doesn't Always Pay to Call Health Ins. Co.

[MIGrandma]

DH recently had a sleep study done. I can't remember the total charge, but seems like it was about $2,000 and "our share to pay" is $73, can't complain at all about that.

Today we received the explaination of benefits from Blue Cross, about the CPAP machine he is now using. Apparantly they paid for some of the components of the machine (humidifier, mask, headgear, etc.) but they won't pay for the machine itself.

The total charges were $1686, with "our share to pay" being $1267 so out of curiosity he called to find out why they wouldn't pay for the machine itself. She didn't know, so had to talk to a supervisor about it, and she called back.

Bad news, they shouldn't have paid for ANY of it. Error in billing. They are going to "request back" the amount they already paid for the equipment, and we are now responsible for the entire bill. Ugh!! Now he's upset that he bothered to call!! She said it would have gotten caught in an audit, and we just would have been billed for it months from now, but still....

So hard to understand insurance companies these days.

 

[IMissEd]

That stinks.

 

[cm8]

DH recently had a sleep study done. I can't remember the total charge, but seems like it was about $2,000 and "our share to pay" is $73, can't complain at all about that.

Today we received the explaination of benefits from Blue Cross, about the CPAP machine he is now using. Apparantly they paid for some of the components of the machine (humidifier, mask, headgear, etc.) but they won't pay for the machine itself.

The total charges were $1686, with "our share to pay" being $1267 so out of curiosity he called to find out why they wouldn't pay for the machine itself. She didn't know, so had to talk to a supervisor about it, and she called back.

Bad news, they shouldn't have paid for ANY of it. Error in billing. They are going to "request back" the amount they already paid for the equipment, and we are now responsible for the entire bill. Ugh!! Now he's upset that he bothered to call!! She said it would have gotten caught in an audit, and we just would have been billed for it months from now, but still....

So hard to understand insurance companies these days.

WOW that is something else. I bet you would be even more upset to know that you could have purchased the same machine and supplies online at less then have the cost you were billed via the DME.

Seems like who ever sold the equipment should have made you aware upfront what was and was not covered by the insurance company. Are you sure that they didn't make a mistake? I thought that BCBS pays for DME and HME . I know each BCBS is different but that seems rather odd. Seems like they should be willing to pay half since they did not inform you of this when you purchased the equipment. Some plans have a clause where the DME/HME provider has to eat the cost of the item in question in they failed to have you sign a release of non coverage for said medical equipment after making them aware of your provider and telling you that it would be covered. I would check into that as well. Good luck.


OP, I would still file a dispute with them and explain that you were told it was covered and go from there.

 

[bdcp]

Wow, our insurance would have paid for 90% of a CPAP. DH decided to try the mouth guard instead and we were reimbursed 90% of that plus the rest out of his FSA so it cost us nothing. We did know they would pay for it as the dentist that did the mouth guard contacted them first. It did take 4 months for reimbursement, but we did get it. Insurance companies are all bracing for the "Obamacare" we've all been forced into. Rates are going up and they're paying out less. Currently, my DH's company pays for all our premiums but we lost our FSA thanks to the fabulous new healthcare law.