I bought a new G4 this past spring with a new Receiver, Transmitter, and 3 boxes of sensors. Edgepark billed me directly for $956.90 but the amount they billed my insurance was $5,140.31 and my insurance payed all of it and said I had no responsibility.
Was I over billed? If my insurance payed %100 why did I get charged? Anyone else notice this?
This is unlike Pump supplies where my insurance gets billed, then I need to come up with the difference.
I find billing a tricky thing. Best to talk to both Edgepark and your insurance. One of them probably made a mistake. Do you normally pay a portion for medical goods? Are your pump supplies considered Durable Medical Equipment? For me Pump and CGMS is DME and I pay 20% and if there is an error it is generally the insurance company who makes it. I know I have gone rounds with insurance to get things squared away.
Also I don’t think Edgepark bills (at least not for sensors maybe they do for the initial receiver). Do you mean they charged you $956.90?
Yes, When I placed the order with Edgepark they immediately charged my CC the $956.90. Then they billed my insurance. The EOB on my insurance says I have no responsibility and they paid the contracted amount to Edgepark. So, something doesn't sound right to me.
Definitely time to call both Edgepark and the Insurance company, don't give up easy it will take multiple phone calls and weeks to get it fixed. I am waiting for a check for $465 to be refunded to me from back in February, Took 3 months and 15 or so calls to get the mistake fixed. I would have fought it harder in the beginning, but I was scared they would hold up my supplies so I sent payment " due upon receipt" They were kind enough to tell me when they realized there mistake they would refund the money in 6-8 weeks. Guess when I will pay them next time they send me a bill, you got it 6-8 weeks. I am well Anthony are you doing well?
I had a similar situation with Edgepark. I used a credit card to pay Edgepark my estimated portion of the cost, and then when the insurance paid the full cost (since I was above the out of pocket max) Edgepark credited my credit card for the amount I had previously paid - and they did this without me me having to contact them.
I think you should contact Edgepark and I anticipate they will take care of it quickly - although you may have to endure the extended hold of their phone system.
Edgepark does this to me all the time. I watch my bills carefully, and always call them on it. They end up refunding it right away without any problems. But I have to wonder what would happen if I didn't pay close attention to my bills and didn't call them. I think it's a pretty lazy way to bill. I've noticed a lot of places have started billing like this. Instead of actually taking the time to call my insurance or look my info up to find out exactly how much I will owe them, they just "estimate" it and charge me for that up front, and then refund me the rest once the insurance has been billed. I had a hospital do this to me once. They wanted me to pay them $200 right up front for an MRI I hadn't even had yet because "that's usually how much people owe us." What does that even mean?! I refused, and made them figure it out with my insurance company. What other service do you over pay for before you even have the service completed? It's so ridiculous.
Anthony, it all depends on what your deductible is, and what your co-insurance is after your deductible has been met. Also, insurance companies will usually negotiate member rates to dictate what they and you will pay for an item. So it's possible that $956 is the difference between their rate and your insurance company rate, in which case you are not obligated to pay. On the flip side, if your deductible has not been met, or your co-insurance is not 100%, then you might still be responsible for a portion of the negotiated total. In the end, you have to speak with your insurance company to determine what your responsibility is (if any), because they ultimately have the last say on those kinds of things =/
$5,140.31 seems to be a crazy amount for a Dex 4 AND 3 BOXES OF SENSORS.... I was under the impression that the G4 kit was about $1,000
seems like your insurance overpaid by like 2x the amount that it costs....
The buck stops at your insurance company. They'll get it straitened out for you. Plus what they are billed and what they pay are different. They will usually end up only paying a "contracted" amount, but the supplier usually bills for more to show a loss on paper. Plus your insurance can fight for you if you were overcharged.
Update - So I called Edgepark this morning. Was not on hold very long and they were very pleasant and helpful. I told them my situation that my insurance BC/BS paid the contracted price of $1,918.80 and that I felt I did not have to pay. She said she would refund my $956.90 to my CC in 3 days. She said the reason for this is that sometimes they do not get the most up-to-date information from the insurance in terms of coverage so that 's why I was billed.
I also asked that Edgepark not bill my CC for my next order of sensors. She said No problem.
So... Had I not inquired about this I would have been out all this money. Very frustrating... but I guess I'm preaching to the chior here.
They would have refunded the $ eventually, but if there were any mistake and the Insurance did not pay, like some things are automatically denied the first two times and miraculously approved on the third time that it is submitted, then you would be out all that cash. I had to submit the sensors three times by phone call to get them approved and the money supposedly refunded. I say supposedly because I still have not received the refund.