Problem with Medical Equipment Vendor: Insurance Issues

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Cruise
Posts: 689
Joined: Mon Nov 21, 2016 7:17 pm

Problem with Medical Equipment Vendor: Insurance Issues

Post by Cruise » Mon Dec 03, 2018 6:50 pm

Hoping that those with industry or practical experience might have some insights on how to protect my interests in this situation:

Back in April 2018, I was prescribed a piece of medical equipment, to be covered by Medicare as primary and another insurance as secondary. I got this equipment through a covered vendor's local office.

Everything was rolling along smoothly, and regular replacement parts were issued on a prescribed schedule by the vendor's national distribution center.

In October, the local office of the vendor contacts me, saying I have to sign new paperwork. On the paperwork, it clearly specifies the equipment was received in April. I send back the paperwork via email copy.

Last Friday, I get a letter from the national vendor, saying that insurance is denying the claim, and that I should return the appliance to the local office of the vendor or pay them $1300+ (they have my credit card on file, but has not been billed before). I call the local office and leave a message. I also email them to inquire "Whats up? And, to document our history." So far, no response from the local office.

What I think has happened is that they incorrectly billed my secondary insurance as Primary, and Medicare as Secondary. (If this is the case, it is their error, not mine.) What I suspect is that they have now resubmitted the claim, but are being denied due to a delay in billing. This is all speculation on my part, but I know that Medicare covers the cost of the equipment that I have.

No way do I want to pay the $1300 for the equipment out of pocket, as the insurance--properly billed--is responsible.

So, does anyone have seasoned advice on how to approach this situation to protect my interests?

Many thanks!

brennok
Posts: 202
Joined: Wed Jun 01, 2016 10:18 pm

Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by brennok » Mon Dec 03, 2018 9:33 pm

Medicare has timely filing limit of 12 months so no issue there. You should have EOBs stating what the insurance companies paid and what your responsibility was. You should be able to contact your insurance to see if they have an updated EOB in case they reprocessed or sent out a request for more info.

Cruise
Posts: 689
Joined: Mon Nov 21, 2016 7:17 pm

Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by Cruise » Tue Dec 04, 2018 1:24 pm

brennok wrote:
Mon Dec 03, 2018 9:33 pm
Medicare has timely filing limit of 12 months so no issue there. You should have EOBs stating what the insurance companies paid and what your responsibility was. You should be able to contact your insurance to see if they have an updated EOB in case they reprocessed or sent out a request for more info.
I appreciate this advice, and the EOB would document the vendor's attempts or mis-attempts to file insurance. I guess my concern is what recourse do I have of they just want to charge my card and be done with insurance? I would think it would violate Medicare guidelines of some sort, but I am not knowledgeable about such matters.

Many thanks if anyone has some insights on how to handle this one.

pdavi21
Posts: 219
Joined: Sat Jan 30, 2016 4:04 pm

Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by pdavi21 » Tue Dec 04, 2018 1:34 pm

1. Don't pay
2. Keep complaining to health provider (and file complaints to BBB, write negative reviews online, file complaints with regulatory authority for insurance in your state)
3. Keep submitting paper dispute forms by mail to both insurance providers (and file complaints to BBB, write negative reviews online, file complaints with regulatory authority for insurance in your state)

Eventually, someone will give in.
Insurance companies always deny, deny, deny and healthcare providers always bill, bill, bill.
Unfortunately, when they should be fighting each other, you have ended up with all the denials and bills.

I'll add that health providers have a lot of leeway to attack your credit score and assets for debts...so at your own risk.

brennok
Posts: 202
Joined: Wed Jun 01, 2016 10:18 pm

Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by brennok » Tue Dec 04, 2018 8:46 pm

Cruise wrote:
Tue Dec 04, 2018 1:24 pm
brennok wrote:
Mon Dec 03, 2018 9:33 pm
Medicare has timely filing limit of 12 months so no issue there. You should have EOBs stating what the insurance companies paid and what your responsibility was. You should be able to contact your insurance to see if they have an updated EOB in case they reprocessed or sent out a request for more info.
I appreciate this advice, and the EOB would document the vendor's attempts or mis-attempts to file insurance. I guess my concern is what recourse do I have of they just want to charge my card and be done with insurance? I would think it would violate Medicare guidelines of some sort, but I am not knowledgeable about such matters.

Many thanks if anyone has some insights on how to handle this one.
Yes the EOB, explanation of benefits, should show everything. You should be able to see every claim filied including corrected claims with updated denials. Also the EOB will show if they paid as primary or secondary. Contacting Medicare would be of some use. It may be you are only covered for so long and your benefits specific to this device are up.

If this was referred by a doctor, you may want to also reach out to the office in addition to speaking with the local device suppliers office in person.

Cruise
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Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by Cruise » Thu Dec 06, 2018 12:47 am

Thanks again for all the responses.

To update the situation, my email to the local office was returned yesterday by a staff member who has been helpful in the past. She said she will review my account and "get back to me." Fingers crossed.

mrc
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Joined: Sun Jan 10, 2016 6:39 am

Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by mrc » Thu Dec 06, 2018 5:14 am

This happens more than you would imagine. It happened to me: I changed insurance carriers and informed them at the time. About 11 months later, I received an OVERDUE WE'RE GOING TO SEND THIS TO COLLECTIONS IF YOU DON'T PAY US NOW bill for $785 for supplies. That was my first indication that something was amiss. Turns out, they never filed a claim with the new company. Sloppy back office generally. Keep a log of your contacts, all your paper records, and stick to the script. You'll get past this. If they do charge your CC, you can dispute the charge with the CC company, but I bet it doesn't come to that.
If it’s not long term it’s small talk

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midareff
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Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by midareff » Thu Dec 06, 2018 8:04 am

#1. I would login to my Medicare account and see if a claim was; a) ever filed b) denied and the reason for the denial. #2. If the equipment is a covered item and the claim was denied I would call to speak with Medicare and ask specifically why.

I have had a couple of denials in the six years I have been on Medicare. The ones that were filed outside the allowed time are not my liability, the ones filed in time but with the wrong codes are not my liability either. Lab claims sent to a wrong lab by a doctor's office are also not my issue either. I have had two denials for items claimed to not be covered despite a physician's prescription for one and a physician's selected lab for the other. In both cases the companies claimed medicare would not pay. I asked to be sent the denials and if they were legit denials I would pay. Never heard from either again.

Ret2018
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Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by Ret2018 » Thu Dec 06, 2018 1:50 pm

Been awhile since I looked at Medicare regs. I seem to remember:
1) Medicare is always secondary payer, ie, the durable medical equipment (DME) supplier must bill private insurance first, then Medicare picks up remainder; and
2) As a Medicare beneficiary you cannot be billed for non-covered items unless you, prior to incurring the charges, signed an "Advanced Beneficiary Notice" in which you acknowledged and agreed to the fact that the charge may not be covered by Medicare and you would be responsible. This is a requirement above and beyond the standard language in most paperwork of "I agree to pay for services...."

Cruise
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Re: Problem with Medical Equipment Vendor: Insurance Issues

Post by Cruise » Tue Dec 11, 2018 1:17 am

Cruise wrote:
Thu Dec 06, 2018 12:47 am
Thanks again for all the responses.

To update the situation, my email to the local office was returned yesterday by a staff member who has been helpful in the past. She said she will review my account and "get back to me." Fingers crossed.
Just got a notice from my local office that the national office has corrected my account, which I am assuming means that they now realize that I do have insurance that covers this!

Thanks again, BHeaders!

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