What is the name of your state (only U.S. law)? OK
How can I find the procedure code for a piece of durable medical equipment. Since no preferred provider of our health plan would sell me a oxygen concentrator (claiming it would violate Medicare regulations, even though the person for whom it was being purchased was not on Medicare), I purchased it from an online provider.
The list price of the equipment was $4000. The purchase price online was $2800. The reimbursement for the purchase was $302. This replaces a piece of rental equipment that was billed at nearly $500/month, paid to perferred provider at $130ish/mo. Its online cost was only $600. In the 2 years of use of the rental equipment, it has been "purchased" over 4 times without us actually "owning" the equipment. In addition, it was not portable so it required the rental of supplementary equipment at nearly $1000/week when we traveled by air. Even the rental of a smaller oxygen concentrator that would fit in the trunk of a car was about $150/week. These costs were not covered by insurance.
Before making the purchase, I had been told that it would be reimbursed at the rate of 60% of cost (approx. $1700) if purchased from a non-preferred provider. I was reimbursed at just over 10%. I am being told that the allowable rental cost based on the coding was $52/mo. It is illogical that a piece of equipment costing approx. 4 times as much would be reimbursed at less than 1/2 the original.
Please let me know who can provide the equipment code to verify it was entered correctly? Please also let me know what I should reasonable expect as reimbursement or how I can determine that?
Other than filing yet another appeal with the company, should I pursue it with the state insurance commissioner?
How can I find the procedure code for a piece of durable medical equipment. Since no preferred provider of our health plan would sell me a oxygen concentrator (claiming it would violate Medicare regulations, even though the person for whom it was being purchased was not on Medicare), I purchased it from an online provider.
The list price of the equipment was $4000. The purchase price online was $2800. The reimbursement for the purchase was $302. This replaces a piece of rental equipment that was billed at nearly $500/month, paid to perferred provider at $130ish/mo. Its online cost was only $600. In the 2 years of use of the rental equipment, it has been "purchased" over 4 times without us actually "owning" the equipment. In addition, it was not portable so it required the rental of supplementary equipment at nearly $1000/week when we traveled by air. Even the rental of a smaller oxygen concentrator that would fit in the trunk of a car was about $150/week. These costs were not covered by insurance.
Before making the purchase, I had been told that it would be reimbursed at the rate of 60% of cost (approx. $1700) if purchased from a non-preferred provider. I was reimbursed at just over 10%. I am being told that the allowable rental cost based on the coding was $52/mo. It is illogical that a piece of equipment costing approx. 4 times as much would be reimbursed at less than 1/2 the original.
Please let me know who can provide the equipment code to verify it was entered correctly? Please also let me know what I should reasonable expect as reimbursement or how I can determine that?
Other than filing yet another appeal with the company, should I pursue it with the state insurance commissioner?