Day in Insurance Hell

Evil Insurance GuyThe sinking feeling started when I saw the envelope from the insurance company. It was highly unlikely that they would be writing to wish me a nice day or send money, and they didn’t. Instead, it was a Claim Summary that basically said I was going to end up owing someone $450. Since I moved and changed employers, I am no longer a patient and they were denying the claim from the company that provided my CPAP machine.

Oops. I really did blow this because I totally forgot that the thing wasn’t mine; it belongs to the durable medical equipment (DME) company. I should have notified someone of the move and found out what to do with the machine but I just forgot. Never having seen any paperwork for it from the DME or the insurance company, little things like payment had never been a factor once I was approved to get it.

Of course, it was after 6pm and everyone everywhere was gone for the day, leaving me to be fret and worry about how to handle it and trying to figure out what the $450 was actually FOR – surely not for one month! Eeeek, that’s ridiculous, I can buy a whole new machine off the web for $900, and I’ve had this one since March. I got myself all worked up into fear that I would have to send back the CPAP that I have immediately so I didn’t get billed for more time, and would just take my chances with breathing until I can get sorted out with the new medical plan.

Today I spoke with medical insurance companies in two states, as well as two DME companies, and our medical center office. I have no more idea what’s happening than I did last night. Basically here’s the deal: the CT insurance won’t provide a new CPAP until I’ve had a new sleep study, which usually ResMed CPAP machine (minus the face mask and tubing)takes at least a month to schedule and another month for the results to be available. I owe my MA DME company for at least two months for my current machine, but magically at $95 instead of $450/month. The CT company may or may not reimburse me if I pay out of pocket.

Of course, if I just keep paying the MA company until December, I will own the current machine. It would be lots cheaper than starting over again here, and even the person I talked to seemed to see the value of saving money. She was also very anxious that I not give up my old machine until we figure out how to get me covered going forward. Which means I pay for it since they’re not sure they can pay for something provided from an out of state provider and prescribed by a doctor outside the plan.

The new medical office people were displeased that my file was so skimpy even when I explained that I was a new patient who hadn’t even been seen by a doctor there because they had to reschedule the one I booked three weeks in advance. It’s a good thing this is NOT an emergency, though perhaps they would be more responsive then.

This is not life-threatening, just annoying and expensive, and I’m a smart person who can figure it out. But even what I did today had me practically in tears. Even so, I didn’t get all snacky and eat my way through the stress and that’s a good step.