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Re: [IP] Balance Billing for Pumps


Do you have the option of changing insurance companies or plans?


Date: Sat, 8 Jul 2000 17:09:05 -0800
From: "Michael" <email @ redacted>
Subject: Re: [IP] Balance Billing for Pumps

> I wanted to throw this out for some feedback. I understand that some
> persons have been "balance billed" directly by the pump companies
> for the difference between what their insurance company pays for the
> pump and the full price of the pump.
 > My question is:
> how many have had this happen to them and if so, how did you deal
> with it?

Generally the up-and-up companies will bill you the difference
between the "contract" amount and the "allowed" amount. That being
the deductible+co-pay. It would really supprise me to hear about the
pump companies doing this as they are both very reputible (MM, D). It
would not supprise me to hear of third party re-sellers doing this
nor would it supprise me for the insurance companies to short pay
using some excuse or another since I've experienced both problems
myself. The pump companies will supply you with the negotiated sales
price if you ask.

My personal experience with this is as follows. After an 18 month
fight with my insurance company, reimbursement was provided
supposedly at 80% (the contract rate). However, the contract amount
that the ins co. listed did not agree with the amount provided to me
by MM, which was higher -- leaving me with a bigger bill to pay. To
make a long story short, the insurance co. had re-negotiated the rate
at a higher pay amount and was attempting to pay only the amount of
the "old" rate. Without the actual contract code numbers supplied to
me by MM, I'm sure it would have been even more difficult to get the
bill paid. The ins co. was trying to pay for a 504, while I received
a 506 for my daughter. They new this, but still tried to argue for
the lower rate. What a bunch of slimes!!!

This type of thing occurs with such regularity on my insurance
re-imbursements that I wouldn't be supprised if there was not a
profit center within the ins co. devoted to short-changing
subscribers to the plan. This happens even with little stuff like
strips on a REGULAR basis. To regular to suit my taste -- they can't
be that dis-organized, can they???
email @ redacted

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