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DME Catheters and Coinsurance

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  • DME Catheters and Coinsurance

    I got on a Blue Cross Blue Shield Medicare PPO over a year ago and was informed today by my DME that I should of been charged 20% each month for my catheters since my plan requires that. That amounts to $168/mnth for 200 closed system catheters a month. They are not expecting me to pay for all the months they failed to do that but expect to do so moving forward.

    I an currently trying to get by on SSDI with $1150mnth so paying $168 is a big chunk and if I pay the max of my coinsurance that would be $3400 which is about 25% of my current yearly income. I find it very frustrating that on the charts they have on the website where they list the plan benefits it is not mentioned at all but of course it is on page 100 something of a 200 page booklet.

    I see the definition of DME is medical equipment that is used at home to provide a better quality of life. Jamming this inside your body to pee is that? I am very UTI prone which is why I use the closed system. BCBS was not able to offer me any assistance and the response was that is how it is and I have to deal with it.

    Does anyone have any suggestions or had a similar experience? Thanks for the help.

  • #2
    Read through this thread, then contact Phil Dye at UTI Medical 877-786-7884 and get his advice.
    stephen@bike-on.com

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    • #3
      Lyerly, This is a common and brutal practice of a lot of insurance companies, they try and pull this crap all the time after the sale in an effort to siphon all the money out of individuals they can. I would call a local attorney and ask him this before you call but here's the truth. Tell them you BCBS by accepting assignment to accept medicare you automatically waived all rights to bill medicare recipients. My understanding is that it's actually illegal and they can suffer extreme fines. I am almost sure, that's even a common practice with DR's any facility that accepts medicare has to accept 80 % payment from medicare and has to take the loss on the other 20%. You can also call a medicare ombudsman. Ok don't hold me to this as legal advice, i just hope you consider what i said and seek professional advice before paying.

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      • #4
        Originally posted by stephen212 View Post
        Read through this thread, then contact Phil Dye at UTI Medical 877-786-7884 and get his advice.
        Yeah, definitely do this

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        • #5
          Thanks for everyone's help. I will look into the suggestions.

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