Well, I think my DME scammed me.  Many of you probably already know bits and pieces of my story but here's some background information that has lead to my current situation.

I worked for Countrywide Financial who was bought out by Bank of America as most of you probably know.  My Countrywide health insurance group plan was through Aetna.

I was diagnosed in late February and given a machine, humidifier, hose and mask by the DME in March.  At this time I asked how the machine was going to be paid for and was told that the policy for my insurance companey (Aetna) will rent the machine for 10 months and then I will own it outright.  I was to be responsible for 40% of the payment and Aetna would pay for 60%.


April 1st was a Bank of America/Countrywide milestone where all Countrywide employees finally converted to the Bank of America payroll and benefits systems.  My group plan changed at this time but BofA also had Aetna and my plan was automatically converted to the new BofA group plan.  The only real difference I saw was my copays went down.  As part of BofA's health benefits, they give their employees a $600 medical reimbursement card funded by the bank.  Basically it was a Visa card with a $600 limit that we could use for anything medical related.

On April 17th I was given a 30 day notice of termination with an 8 week severance package starting on May 17.  Because of the current economic situation we are in and the poor job market, I called my DME to arrange a settlement for my machine.  I told them about my situation of pending unemployement and loss of health benefits and asked if I could make a one-time payment to pay off my machine in full so that I would be able to keep it without worry of losing it.  The lady had to call her 'director' to see if this was possible and later called me back to inform me that they were willing to do this.  I made a single payment of $487 on my BofA health reimbursement card and was told that I owned the machine.

I also mentioned this in another call about 6 weeks later and the lady had no idea what I was talking about.  After some research she said she did find some notes that stated that I had bought the machine and she confirmed the purchase.  This concerned me a little but I let it go.

Fast forward to today...

My group insurance with Bank of America expires on 7/31 and because I have not been feeling as rested as I would like I had another titration study conducted before it runs out.  During my follow up visit with the sleep Dr I received a RX for a BiLevel machine.  I was lucky in that I found new employment but I am also now faced with very, very high group insurance and no coverage (preexisting condition) for OSA under an individual plan.  If I elect to enroll with my group plan it will cost me $115 per week.  Because of these extremely high group rates I called Aetna to see if there were any options available to me to buy a new machine.  Of course the answer was no but they did alert me to a weird issue where they were still paying the DME monthly installments for the machine I thought I owned.  So I called my DME next to see what individual payment plan options might be available to me.  The idea was to see if the overall cost might be lower if I were to get an individual plan for myself and make payments on a new machine out of pocket.  I also asked if I could trade in the machine I own for a partial credit towards a new BiPAP.

Here's where this gets really, really ugly.  For starters, the lady I spoke to said the BiPAPS run around $1,600.  When I told her that was doable and told her which machine I was looking into (the Resmed S8 VPAP Auto 25) she said oh no, that one has more features than I need and is VERY expensive.  So I guess it's not like the others that fall into the $1,600 range.  An interesting note is that this machine costs about $1,500 online.  Okay fair enough, but since you are not billing an insurance company and are instead billing an individual, is it possible to bring the cost down?  No.  Okay fair enough, is it possible to return the machine that I paid $487 for back in April and get a partial credit towards a new machine?  No, because according to her, I don't own the machine.  Oh that's right, Aetna did say they were still paying for it, why is that exactly while I have you on the phone...?  Wait a sec, hold that thought...  Did you just say I don't own the machine?  What about the money I paid back in April to ENSURE I OWNED THE MACHINE?  Nope, according to her I only prepaid for 10 months of rental payments.  According to the lady I spoke with, Aetna changed their policy (I will be calling Aetna shortly) at some point and instead of paying 10 months of rent to own, they now only pay rent for the entire life of the machine.  So really, it's not  a rent to own policy anymore rather it's a lease policy.

What am I suppose to do?  Somehow I got completely ripped off here.  Is this even legal?  Unfortunately I don't have a receipt or record of sale for this machine.  I have a verbal "You own it" response over the phone that I trusted was true.  Now apparently I never owned it despite what I was told and I am at risk of losing it.  Not only did I prepay for 10 months of "Rent" but it was only MY PORTION of the rent.  The $487 was only 40% since Aetna was paying the other 60% of the payment.  That leaves me with like 2 months left of 100% payment.  Lets go back to the part where I paid for the machine though.  How does rent have anything to do with anything when supposedly I bought the machine outright?  It shouldn't but I have no documentation showing that I own it.  No receipt.  No document showing that it was paid for.

Okay so what do I do?  I am SO MAD at these people now.  I could have taken that card and purchased the same machine with humidifier brand new from an online source and owned the thing outright?  I am truly upset.  Luckily between my family and friends I think I can come up with the $ to buy the BiPAP I need but what gives these people the right to do this?  Do I have any legal ground to stand on here?  At the very least I am going to file a complaint with the Better Business Bureau.

Am I allowed to post the name of the DME so that people can avoid them in the future?

Quote:

As part of BofA's health benefits, they give their employees a $600 medical reimbursement card funded by the bank.  Basically it was a Visa card with a $600 limit that we could use for anything medical related.

...  Unfortunately I don't have a receipt or record of sale for this machine.  

You should be able to get a statement on that Visa debit card just like you would with any other card, but you will probably need to request it.  If I were you, I would start there, and establish ownership of the machine before anything else.

Update:

I called my insurance company to explain everything to see if I could get any more information about why they were still making payments on my CPAP.  After I explained the whole situtation the insurance rep called the DME and got the original lady on the phone who worked out the purchase with me.

The woman said that I do in fact own the machine and that the other person I spoke to last night didn't understand that there was a termination in my insurance and basically just wasn't in the loop.

So this person is saying it's all good.  She also said that I could apply the payment to a new BiPAP machine if that's what I need and then arrange a payment plan to pay off the remaining balance.  This is a relief to me and I feel better after talking to her today but I did make sure to insist that they mail me a bill of sale and a formal, signed letter from the company stating that I have purchased and own the machine.  She agreed to mail those documents.  Assuming they mail them I'll just leave it as a lack of organization and communication on their part and forget about it.  I may still opt to buy a BiPAP online and keep the CPAP as a backup.  I have a feeling their prices are going to be a lot higher.

The prices from a DME are much higher... for the personal service rendered?  .... The insurance pays a contract price which is much lower then the DME's retail price... and more inline with the online prices, though still higher....the DME then can write off the difference.  The higher amount is for the services they have agreed upon to render, used ro not used by the patient.  Those service may include things such as mask fitting, in-home service (mine does this), loaner machines if needed etc.  The online is a simple store...just like buying an appliance, TV etc....

You should not have a problem with the new insurance due to pre existing conditions as long as you have proof of continual coverage of insurance....or if there is a gap in time from being insured by the old company..it has to be less than ???63 days???.  If you have been insured all along then they can not refuse for preexisting.  

Sounds like you are still with aetna...the new insurance can not claim pre exisiting.


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I am A ZOMBIE! 20 years+ undx'd. BiPAP Auto M 14/9. Nasal Swift&F&P Flex Fit 431 Full Face. RLS/PLMD, Primary CNS Hypersomnia, Sleep Paralysis, Parasomnia, Degenerative Disc Disease, Clinical MS, Fibromyalgia, COPD plus other past dx's..what's next?

Quote:

You should not have a problem with the new insurance due to pre existing conditions as long as you have proof of continual coverage of insurance....or if there is a gap in time from being insured by the old company..it has to be less than ???63 days???.  If you have been insured all along then they can not refuse for preexisting.  

This component of HIPAA only applies when going from one employer-sponsored plan to another.  Not when going from employer-sponsored to a non-employer individual plan.

Mrs Rip Van Winkle wrote:

The prices from a DME are much higher... for the personal service rendered?  .... The insurance pays a contract price which is much lower then the DME's retail price... and more inline with the online prices, though still higher....the DME then can write off the difference.  The higher amount is for the services they have agreed upon to render, used ro not used by the patient.  Those service may include things such as mask fitting, in-home service (mine does this), loaner machines if needed etc.  The online is a simple store...just like buying an appliance, TV etc....

You should not have a problem with the new insurance due to pre existing conditions as long as you have proof of continual coverage of insurance....or if there is a gap in time from being insured by the old company..it has to be less than ???63 days???.  If you have been insured all along then they can not refuse for preexisting.  

Sounds like you are still with aetna...the new insurance can not claim pre exisiting.

When you say new insurance cannot claim preexisting, do you an mean individual plan or the group plan that is available through my employer?  The group plan I'm sure will cover it but it's $460/month.  I think at those prices it makes more sense to just buy the machine out of pocket because I could pay a machine off with 4 months of insurance payments.  If I go through my new group plan (also Aetna) so that I can get covered for the machine, not only would it cost $460 a month but I'd also be liable for part of the machine rental payments for up to 10 months.  At a minimum of $460 a month to cover the premium that would cost me $4,600 in 10 months (not including rental cost).  I could get on an individual plan at $150 (or less if I choose a higher deductable) the machine + premium is only $3,000 combined over 10 months.  Mask cusions will add a bit to this, but would it add up to another $1,600?  I don't see how it could.  I really don't understand insurance very well and after the whole insurance rental/payment thing with Aetna and my DME I'm even more leary but am I figuring this right or am I overlooking something?

I'm not sure I want to pay an extra cost to my DME for 'service' either at this point.

Be sure to get the same brand and series bi-level as your CPAP if they use the same integrated humidifier to save yourself that extra cost.

Keep in mind that these local DME suppliers shell out upfront for an inventory of CPAPs, etc. on their shelves but then only receive their reimbursement in dribbles and drabbles over 10 to 13 months whereas online DME suppliers work on a cash basis and get their money upfront when they sell a CPAP.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I am interested to know what supplier this is.


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Previous Mask: F&P Zest (did not like)
Current Mask: Resmed Swift LT for her (nasal pillow)
CPAP: F&P Sleep Series 234

The DME is Lifecare Solutions headquartered out of California.

They did send me a letter stating that the machine was paid for and that I own it.  They haven't called me about a payment plan for a BiPAP yet.  I don't know if it will be affordable to me or not.

ApexAZ, that's a big difference in cost between the individual plan and the group plan.  Do compare them carefully to see what is missing in the individual plan - and read the fine print, even if you find it difficult, because it will be written in legalese which, as we know, is a strange dialect of English.  A plan that cheap may well be so limited it's not worth having.  

I'm not trying to claim any sort of expertise in comparing insurance plans because I am Canadian and don't need one but I've had experience reading other legal documents!