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Thread: Is my wheelchair vendor trying to pimp me?

  1. #1

    Is my wheelchair vendor trying to pimp me?

    I ordered my new wheelchair at a cost of $3740 as billed by the vendor per the EOB. Per the contracted rate, insurance paid $2108 and my coinsurance is $527. The patient savings is $1104 which BCBS says I am not responsible for paying.

    Now, my vendor advised me my payment was $1500, but with a discount I would only pay $995 out-of-pocket. Now my insurance says my coinsurance is $527 and the vendor says it's $995. I am sure they are trying to recoup some profit, but I am wondering is this legal or allowed. I haven't paid anything yet, but am just curious.

  2. #2
    Senior Member
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    If your primary insurance is medicare with BCBS as secondary this is not legal.

  3. #3
    Not ok with Blue Cross as a primary either I don't think. The EOB says what you are to pay, and probably says you are not responsible for the discounted amount.

    I'd pay what the EOB says you should, and no more.

  4. #4
    Quote Originally Posted by Eileen View Post
    If your primary insurance is medicare with BCBS as secondary this is not legal.
    I have a Medicare Advantage plan with BCBS. That's what I thought. If they try and hold the chair and force me to pay the amount they want, I assume I should contact the insurance company first and advise them of the issue?

  5. #5
    Quote Originally Posted by Wheelieboy View Post
    I have a Medicare Advantage plan with BCBS. That's what I thought. If they try and hold the chair and force me to pay the amount they want, I assume I should contact the insurance company first and advise them of the issue?
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  6. #6
    Senior Member DaleB's Avatar
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    That's called 'balance billing' and it's against the rules for HMO's and
    PPO style plans. It might be a fight to get the DME to agree, but he has to accept the contracted price from the insurance company if he's a participating provider in their network. "Balance billing" isn't illegal, per se, but it is very much against the rules in 99 out of 100 provider - payer contracts.
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  7. #7
    Quote Originally Posted by DaleB View Post
    That's called 'balance billing' and it's against the rules for HMO's and
    PPO style plans. It might be a fight to get the DME to agree, but he has to accept the contracted price from the insurance company if he's a participating provider in their network. "Balance billing" isn't illegal, per se, but it is very much against the rules in 99 out of 100 provider - payer contracts.
    As I suspected. The DME sales guy left a message on Friday, but I didn't call him back. I only intend to pay what he is allowed. If he balks then I will just act a fool at time (professionally of course). The plan is an HMO. I'm certainly not paying more than he's entitled to. He can bitch and moan, but I am not one to get screwed where money and insurance is a concern. Yes, the company is a participating provider with the Medicare Advantage plan.
    Last edited by Wheelieboy; 11-15-2009 at 07:19 PM. Reason: detail

  8. #8
    Bastids !!!

  9. #9
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    Unfortunatly disabled people get screwed far too much in society. I once wanted to get a gym membership that was $30 a month with free initiation but the guy figured out a way to get me to pay for over $500 in stuff I didn't need when I told him I already know how to use the equipment in gyms so I don't need a personal trainer and I'm in a wheelchair so I won't use the sauna or pool or stuff like that. I got my money back and want somewhere else. With a friend present. Unfortunatly it sounds like you are being taken advantage of and the guy should be fired. Play it safe and don't pay for what you know you don't have to. I learned that the hard way.

  10. #10
    I agree to Eileen. If BCBS is the secondary it is not allowed.

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