Insurance dilemna - oh crap!

Here’s my dilemma:
I’d been arguing with my diabetes infusion set/pump cartridge supply company about billing for awhile. They used to charge me as a Rx, but then switched the coding as durable medical equipment (meaning I pay more $). My insurance company has also been a pain to deal with and not helpful. Long story short: plan I have (BCBS-MA) is different than the one that bills (BCBS-OR), and neither one will talk with each other.

So now, the pump supply company has sent the bill to collections. Crap!!!

Do I pay the collections bill with the interest, or continue to fight?

I don’t use a pump but I actually believe that the general standard throughout the insurance industry is that insulin pumps, CGMs and all the supplies associated with them are considered DME. In some cases I’ve heard people being able to get their insulin for use in a pump covered under DME at cheaper costs. Unfortunately my experience is that insurance policies related to what is DME and what is pharmacy are not written down and hence can be subject to change and stuff like you have experienced.

You certainly have a right to appeal any coverage decision and there is a process to do that. There are timelines associated with those appeals but you could certainly argue that you should have those waived. But in the end you may just not win. After all, it may just be you got a total deal by having stuff covered as pharmacy where most others had to pay coinsurance as DME.

In either case I would recommend that you offer to pay the bill so it doesn’t hurt your credit. Not paying your bill doesn’t give up your rights to appeal the bill. And if you start an appeal you can make a reasonable argument that you should not be subject to interest.

I have BCBS-MA too, but I haven’t run into this. What supply company do you use?

I would also only deal directly with the biller, not the collections company. Pay the billed amount, not the interest. Also, you could ask if they will offer a no-interest payment plan if budgeting is a concern.

Like @Brian_BSC said, I would also appeal and I would also document everything possible, dates, names, etc.

Thanks, Brian.
It’s my understanding that they chose to code with the DME code mid plan year (per Oregon’s instructions) and not under pharmacy benefits (per my Massachusetts plan).

Is it already on my credit score? Do I pay the collector or the vendor?

I have BCBS-MA, but because I live in Oregon BCBS makes them bill Oregon. However, Oregon has a different idea about what I need to pay from MA and they are the ones that dictate how the vendor submits the coding. Oregon refuses to speak with me since I am “not in their plan”

I had CCS Medical, but they are no longer going to sell through BCBS-OR.
Now I have Edgepark and they are saying it is DME.

Who do you have?

Thanks, YogaO.
Is it too late to deal with the biller or will they force me to deal with the collections agency? Do I have any ground to not pay the interest or could that just blow up in my face?

I use Liberty, who are plenty inept and infuriating in their own right but haven’t actually denied that my stuff is legitimately in their purview. They just suck at delivering things in time. And telling the truth. -Oh sure, it’ll be there by Saturday. -What do you mean someone told you Saturday? It was shipped on Saturday. -What do you mean someone told you it was shipped on Saturday? It hasn’t cleared documentation yet! Etc.

Hi, I’m stepping in not knowing all the facts, but wish to add my own.

Two years ago (being new to Medicare), I hunted for a medical supply company where I could continue getting my 3 month supply of Omnipod, under DME plus an AARP supplemental plan. Medicare gave me a list of possible suppliers (close to 20 or so). After many phone calls I found a co in Fla who told me they carry the pods, and that they work with Medicare. They asked the necessary questions and got back to me 2 days later saying I was approved and my supply was being sent.

Long story short, when I called 3 months later for next shipment, was told Medicare would NOT cover it. I appealed Medicare decision twice and lost. Meanwhile was never billed the $1,800 charge from supply co that sent it, because they wrongly assured me that I was covered.

Somehow something got lost in the works and I am somehow managing to procure necessary pods to take me into the next year but at an expense that isn’t justified. :tired_face:

Receiving supplies

You typically have 30 days at least before something from a collections agency would be reported on a credit report. And I agree with @YogaO, pay your DME supplier, not the collection agency. If something does get reported on your credit report you can dispute the report and it is up to the collection agency to validate the report. If you paid the bill then it will be likely just be removed from your credit report even if it has been reported.

By law you are entitled to one free copy of your credit report from each of the three major credit reporting companies. In addition, many of us likely have free access to our credit report any time through places like our banks.