Durable Medical Equipment: Read the contract!

Read the small print when signing for durable medical equipment.  If you don’t pay attention, it could cost you a lot of money. Not reading the small print is costing a client of mine $715.08 – and I don’t think this is right.

Alana is enrolled in a Medicare Advantage plan that has fairly low co-payments for doctor visits, lab tests, and hospital stays.  She had surgery on her foot and it was not healing, so her doctor prescribed a machine that massages the foot and stimulates bone growth and healing.

It took a while for Alana’s Medicare Advantage plan to approve the order for the machine, which falls under “durable medical equipment”. On every Medicare Advantage plan I have seen, there is a 20% co-pay for durable medical equipment (DME), and this is the case with Alana’s plan.

NOTE: DME includes oxygen, nebulizers, concentrators, CPAP, wheelchairs, crutches, hospital beds, and many more items.

The machine Alana received is called the OL 1000 Growth Stimulator. It is a portable, battery powered medical device about the size of a bread box.  The person who delivered the machine showed Alana how to use it. He also had her sign a contract that has lots of small print.

Alana assumed she was renting the machine, since that’s how most DME is handled.  She asked the company representative how she would return the machine, and he said she could call the company when she was done using it.  This person never told Alana what the machine would cost her. In fact, nobody every talked to Alana about what her co-pay would be for this machine.

Alana  showed me the bill and the form she signed when she received the OL 1000.  I read the small print and….. uh, oh….. it says that while most DME is rented, the OL 1000 must be purchased.  The bill says:

Original Invoice:  $4,200
Payment [insurance company]: $2,860.32
Current invoice balance:  $715.08

Alana doesn’t have $715 to spare, so she agreed to pay the company $20 per month. I don’t think she should have to pay this bill, and here is why:

On the back of the contract Alana signed, there is a “Patient Bill of Rights and Responsibilities”. It is a long list, but two of rights would seem to apply to Alana’s situation.  It says, “You have the right to:

– Know charges for services including fees covered by patient and those covered by insurance…
– Make an informed decision about services.”

I have contacted Alana’s Medicare Advantage plan about this problem. I have left a message with the company that billed Alana. Hopefully, I’ll have feedback next week. I think I should be talking to Medicare as well – but I’ll wait and see what I hear from Alana’s Advantage plan, which approved the expensive machine and never advised Alana of her co-pay.  And I’ll see what the DME company has to say about not having informed Alana about the cost of the machine. She certainly would have said “no thanks” if she knew she would be billed $715.

Stay tuned.

UPDATE:

Thanks to a very helpful manager at the Medicare Advantage plan in question, the $715 bill has been paid – and not by my client!

I made a call to the company that “sold” Alana the very expensive foot massager, and I exchanged several emails with the Broker Manager for the Advantage plan. It was clear to me that Alana was never told how much she would have to pay for the use of this machine – though the Advantage plan sent her a notice advising her that a co-pay would be required for DME. I pointed out to the Advantage plan that the notice was missing one important thing – the actual cost to Alana!

In the end, the Medicare Advantage plan will pay the $715 that was Alana’s 20% co-pay for durable medical equipment.