I have severe sleep apnea and have been comparing costs with my local DME and online out-of-network DME supplier websites. Since I’m on a high deductible plan, I’m attempting to find the most cost effective way to purchase replacement equipment.
If I buy from DME, I pay more, and it will go against my deductible, but if I buy online I save money, but it won’t go against my deductible.
I recently ordered a new mask + headgear + pillows, which they ordered as a pre-assembled unit.
They billed my insurance for three separate codes:
A7034 – Pillow Mask A7033 – Pillows A7035 – headgear
I asked them if they billed insurance differently for a pre-assembled mask compared to the individual parts and they said no.
I called my insurance to ask if there was a separate code for each part of the mask, they said they cannot tell the DME what codes to use and that I should ask my DME.
In the end, the claim was for ~$340, of which my negotiated price was around $200 for mask + heated tube.
On cpap.com if I were to buy the parts individually the price would be around $107, but as a pre-assembled mask, around $78.
Is there an insurance code for the pre-assembled mask that would be different than the individual parts; or does the coding system not handle the scenario that the mask is sold with all three parts?
submitted by /u/gx1400
[link] [comments]
I have severe sleep apnea and have been comparing costs with my local DME and online out-of-network DME supplier websites. Since I’m on a high deductible plan, I’m attempting to find the most cost effective way to purchase replacement equipment. If I buy from DME, I pay more, and it will go against my deductible, but if I buy online I save money, but it won’t go against my deductible. I recently ordered a new mask + headgear + pillows, which they ordered as a pre-assembled unit. They billed my insurance for three separate codes:
A7034 – Pillow Mask A7033 – Pillows A7035 – headgear
I asked them if they billed insurance differently for a pre-assembled mask compared to the individual parts and they said no. I called my insurance to ask if there was a separate code for each part of the mask, they said they cannot tell the DME what codes to use and that I should ask my DME. In the end, the claim was for ~$340, of which my negotiated price was around $200 for mask + heated tube. On cpap.com if I were to buy the parts individually the price would be around $107, but as a pre-assembled mask, around $78. Is there an insurance code for the pre-assembled mask that would be different than the individual parts; or does the coding system not handle the scenario that the mask is sold with all three parts?
submitted by /u/gx1400 [link] [comments]Read Morer/HealthInsurance