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Buying vs Rental and insurance

Posted by PamC on July 18, 2002 at 16:23:21:

Wanted to describe a situation I am in that everyone who rents with insurance, especially newbies, may want to be aware of. I have been on CPAP for a year and a half and have been on this site since then. There was a post around that time about the poster's insurance company paying the rent on a machine and when the cost of the machine was covered, the machine becomes the property of the insuree (poster). The person posting had been given a used machine to rent and was upset that the machine that had been paid for was used from the start, but the insurance paid on it as if it were a new machine. They managed to get a new machine from the DME after some effort. Because of that posting, I talked to my insurance company and asked about the renting and if it would be better to buy outright. I was told that the policy would not cover a purchase and that they would pay for what I understood as "infinitely". Even after some prodding, had no idea that I would someday own the machine under the terms of my policy. Didn't make sense economically but figured that I would go along with it.

Now, I get my explanation of benefits and the last bill from the DME has been denied for the reason that I have reached my lifetime max. Now they tell me that I have a max of "the cost of the machine" for the rental (but when you do the math, they could have purchased at least 4 machines). I told them that I had been given a used machine for my rental and that it didn't make sense that they had paid so much for this used older model machine. It works fine, but it is an outrage that they let this happen. They assured me that if my CPAP would break, they would pay for repairs or replacement should it be unrepairable, but that I should talk with my DME and settle the billing problem so that I don't get charged rent anymore and to address the issue of the older machine.

The procedure for getting the billing settled alone took 3 transfers on the phone. Felt like they didn't know what I was asking for, but finally got that settled. However, the supervisor will need to call me back tomorrow about the age of the machine.

Hope this helps someone deal with their insurance company and DME. If I had gotten the right info from the insurance company in the first place, I would have insisted on a new machine early on.

I will keep you posted on what happens.

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