I have just received my explainations of benefits from my sleep study and equipment.  I don't understand them completely and am wondering is anyone out there would know why i got two charges one on the evening i entered the sleep lab and one for the next day also each to the tune of $2700.  I am expected to pay my part and that is fine.    Also, i got penalized on my insurance for $250. for not having the dme company do the precertification, as they said they would contact my company. But there are other questions.  If someone responds, i will elaborate.  All of this makes me grouchy and that is counterproductive to my getting better...i certainly don't need more stress.   thank you
hoosierkitkat

I just had a sleep study done on the evening of 14-Sept-2005.  Before going in I rang up Blue Shield and asked them about the clinic and what I might expect for expenses.  From that conversation I learned the approved cost of the study with Blue Shield is ~$1,300.  Of that amount I will need to contribute 20% of the billed amount, which I expect to be at the maximum allowed.  On top of that, I haven't used any of my deductible, so I had to pay the clinic $500 up front so they would accept the appointment.

I haven't purchased any equipment yet, but I expect I'll pay ~$1,050 for a top of line APAP, mask with headgear before my OSA spending is done.  I haven't paid anything yet because there were problems with the sleep clinic's execution of the testing and because I would have wanted to see the results before I would accept a machine.  I also wanted the hardware spending to be separate from the testing, but I wouldn't have minded buying it from the clinic if they were reasonably competitive and hadn't made a mess of the testing.

If the clinic didn't get prior authorization you might find you have a good bargaining position to get the amount adjusted down.  Ring up your insurance company and ask them what they would have authorized with a preferred provider.  Ask about the amount you have to spend on the hardware as well.  With this information in hand you can make a good case for the clinic to accept this amount as they breached the agreement they had with you to obtain the approval.  Keep in mind they might have called the insurance company and learned what the insurance company was willing to pay and rejected that amount by telling you they forgot.  Whatever reason it didn't get reflected in the billing, you still have good position and it would be a good case to take to small claims court.  You also have the power of the pen with your local BBB, Chamber of Commerce and state-licensing agency.  Medical clinics don't like bad press of any kind especially when they are the cause of irritation.


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Thanks,
Roger...