OT: does anyone work in medical billing/for an insurance company?

sherry7899 · 01-10-18, 04:29 PM

I am so sorry to ask, but I need help.

My DH has sleep apnea. Last summer the CPAP machine he used for years died. He got another one, which we opted to put a deposit on and make monthly payments until it was paid for ($700 total). Our insurance would not cover it at all because we had not reached our deductible.

My DH's employer changed insurance carriers as of January 1st of this year.
Now the company we have been paying since last summer says that since our insurance company changed, the payments/deposit we made may not count at all.

We have only two or three payments left until he owns the machine. This makes NO sense to me at all.The insurance company did not pay anything at all towards the machine. Why should it matter if our insurance changed if we're not getting any help paying for it from insurance? We assume (which is fine) that our new insurance carrier would not pay towards it either since obviously we would not have reached our deductible.

Someone is supposed to get back to me about this. This seems like double billing and a rip off to me.

Any advice/help on how to deal with this would be appreciated. I am going to look up the company on the Better Business Bureau site to see if this has happened to anyone else.

The rental company seemed totally perplexed by this issue. We cannot be the only people EVER to have changed insurance carriers before something was paid off.

kristiep · 01-10-18, 04:46 PM

Quote:

Originally Posted by sherry7899

My DH's employer changed insurance carriers as of January 1st of this year.
Now the company we have been paying since last summer says that since our insurance company changed, the payments/deposit we made may not count at all.

I don't work for an insurance company but I am trying to work through the logic on it.

The company providing the CPAP machine is wrong in my opinion. They should not care who pays the bill -- you or insurance. As long as they get paid, they should be satisfied. Furthermore, your previous insurance plan would not have covered it anyway. Payment was coming from you, and they would know that.

Did you explain it to them this way (or use similar logic)? What did they say? How can they take money from you and not provide the product or not refund your money? It was not a donation; it was payment towards a product.

sherry7899 · 01-10-18, 04:52 PM

Kristie, I did explain it that way, and all they said was that they needed "research it and get back to me." We have had the machine since last summer and have been paying for it. It makes no sense whatsoever. If they call back tomorrow, I will restate the same thing and ask for a supervisor or manager.
I checked the BBB site and they have no ratings at all.

frostyjan · 01-10-18, 05:03 PM

Quote:

Originally Posted by sherry7899

I am so sorry to ask, but I need help.

My DH's employer changed insurance carriers as of January 1st of this year.
Now the company we have been paying since last summer says that since our insurance company changed, the payments/deposit we made may not count at all.

Are you sure they aren't saying that your payments may not count toward the deductible of your new insurance?

If you have paid the company in order to own the machine, I don't see how the money they have received won't count??

donnamp · 01-10-18, 05:18 PM

I agree, I don't see how a change in insurance would make a difference about something you were paying for without insurance. Maybe they meant it wouldn't count toward your deductible as frostyjan said.

Good luck with this - it is a nightmare dealing with and untangling this stuff!!

Donna

sherry7899 · 01-10-18, 05:28 PM

Thanks! From what the rep was saying, she made it seem like the payments would not count towards the cost of the machine, which makes no sense at all.
Hopefully they will call back tomorrow. I just don't need this aggravation!

cyana · 01-10-18, 08:24 PM

Sherry - don't hesitate to request this be elevated to a manager at the DME (durable medical equipment) company. The one and only thing I can think of that could be a wrinkle since you're paying out of pocket - was the $700 a contracted rate through the prior network? Even so, there should be some assistance through your current insurance network to coordinate the benefits through this changeover and I'd keep digging until someone at your current insurance network or husband's employer jumps in to help.

If needed, check and see if your husband's employer and/or medical insurance plan has an advocacy program (frequently referred to by some twist on a name such as Medical/Health Advocate/Advocacy). They may be able to assist you with this. You can also check with the customer service # on the back of your insurance card to see if the new network has a benefits coordinator who can step in. And don't hesitate to contact Human Resources and see if they can get you pointed in the right direction. Your husband's employer may have an employee web site that provides contact information for HR/medical benefits questions.

Good luck in getting a quick resolution.

Lucky Star · 01-10-18, 10:30 PM

Quote:

Originally Posted by cyana

Sherry - don't hesitate to request this be elevated to a manager at the DME (durable medical equipment) company. The one and only thing I can think of that could be a wrinkle since you're paying out of pocket - was the $700 a contracted rate through the prior network?

That's the first thing I thought of. Your prior insurance may not have contributed to payments but they probably contacted a special price. Last year I had a number of procedures done which we had to pay for because my deductible hadn't been met, but what I paid (which was still a lot to me!) was a fraction of what I'd have been charged without insurance.

Whatever the reason I hope you unravel this mess soon, and in your favor!!

Scorpio6 · 01-11-18, 12:05 PM

Get a lawyer who specializes in medical malpractice, they have plenty of experience making insurance companies toe the line.

cindyw75 · 01-11-18, 12:12 PM

Just going off of my personal experience with dealing with insurance companies and deductibles...

Not having met your deductible, sometimes means that your insurance will cover part of it, but you have to pay a certain amount to meet the deductible. You might have been making payments toward what your responsibility would have been to meet the deductible, and your insurance would pay for the rest. For instance, I pay $120 towards my deductible so my daughter can see her cardiologist. The insurance still pays part of it.

For my daughter's braces, we signed a contract, where we pay $100/month for 30 months. However, if our dental insurance changes, we would be responsible for more, since the insurance would stop paying their portion.

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01-10-18, 04:29 PM
sherry7899 Join Date: Jun 2003	OT: does anyone work in medical billing/for an insurance company? I am so sorry to ask, but I need help. My DH has sleep apnea. Last summer the CPAP machine he used for years died. He got another one, which we opted to put a deposit on and make monthly payments until it was paid for ($700 total). Our insurance would not cover it at all because we had not reached our deductible. My DH's employer changed insurance carriers as of January 1st of this year. Now the company we have been paying since last summer says that since our insurance company changed, the payments/deposit we made may not count at all. We have only two or three payments left until he owns the machine. This makes NO sense to me at all.The insurance company did not pay anything at all towards the machine. Why should it matter if our insurance changed if we're not getting any help paying for it from insurance? We assume (which is fine) that our new insurance carrier would not pay towards it either since obviously we would not have reached our deductible. Someone is supposed to get back to me about this. This seems like double billing and a rip off to me. Any advice/help on how to deal with this would be appreciated. I am going to look up the company on the Better Business Bureau site to see if this has happened to anyone else. The rental company seemed totally perplexed by this issue. We cannot be the only people EVER to have changed insurance carriers before something was paid off. __________________ "Say you are tired and you will be. Believe you are strong and you are." (Sean O'Malley) The cat in my avatar is my sweetheart named Bonkers

01-10-18, 04:52 PM
sherry7899 Join Date: Jun 2003	Kristie, I did explain it that way, and all they said was that they needed "research it and get back to me." We have had the machine since last summer and have been paying for it. It makes no sense whatsoever. If they call back tomorrow, I will restate the same thing and ask for a supervisor or manager. I checked the BBB site and they have no ratings at all. __________________ "Say you are tired and you will be. Believe you are strong and you are." (Sean O'Malley) The cat in my avatar is my sweetheart named Bonkers

01-10-18, 05:18 PM
donnamp Join Date: Nov 2001 Location: Maryland, USA	I agree, I don't see how a change in insurance would make a difference about something you were paying for without insurance. Maybe they meant it wouldn't count toward your deductible as frostyjan said. Good luck with this - it is a nightmare dealing with and untangling this stuff!! Donna

01-10-18, 05:28 PM
sherry7899 Join Date: Jun 2003	Thanks! From what the rep was saying, she made it seem like the payments would not count towards the cost of the machine, which makes no sense at all. Hopefully they will call back tomorrow. I just don't need this aggravation! __________________ "Say you are tired and you will be. Believe you are strong and you are." (Sean O'Malley) The cat in my avatar is my sweetheart named Bonkers

01-10-18, 08:24 PM
cyana Join Date: Dec 2001	Sherry - don't hesitate to request this be elevated to a manager at the DME (durable medical equipment) company. The one and only thing I can think of that could be a wrinkle since you're paying out of pocket - was the $700 a contracted rate through the prior network? Even so, there should be some assistance through your current insurance network to coordinate the benefits through this changeover and I'd keep digging until someone at your current insurance network or husband's employer jumps in to help. If needed, check and see if your husband's employer and/or medical insurance plan has an advocacy program (frequently referred to by some twist on a name such as Medical/Health Advocate/Advocacy). They may be able to assist you with this. You can also check with the customer service # on the back of your insurance card to see if the new network has a benefits coordinator who can step in. And don't hesitate to contact Human Resources and see if they can get you pointed in the right direction. Your husband's employer may have an employee web site that provides contact information for HR/medical benefits questions. Good luck in getting a quick resolution. __________________ "People are unreasonable, illogical, and self-centered. Love them anyway." — Mother Teresa "I've decided to grow old disgracefully." - Twigs

01-11-18, 12:05 PM
Scorpio6 Join Date: Jul 2009 Location: St. Louis MO	Get a lawyer who specializes in medical malpractice, they have plenty of experience making insurance companies toe the line.

01-11-18, 12:12 PM
cindyw75 Join Date: Aug 2016 Location: Southern California	Just going off of my personal experience with dealing with insurance companies and deductibles... Not having met your deductible, sometimes means that your insurance will cover part of it, but you have to pay a certain amount to meet the deductible. You might have been making payments toward what your responsibility would have been to meet the deductible, and your insurance would pay for the rest. For instance, I pay $120 towards my deductible so my daughter can see her cardiologist. The insurance still pays part of it. For my daughter's braces, we signed a contract, where we pay $100/month for 30 months. However, if our dental insurance changes, we would be responsible for more, since the insurance would stop paying their portion.