New Machine - DME Messing With Me?

[jb1654]

Hi everyone, I could really use some help with this situation.

Diagnosed 2008, DME gave me a ResMed S8 Compact. I had Blue Cross Blue Shield, best insurance of my life, never really paid attention. They bought it, so I own it free and clear. After reading this board for awhile, I've decided that I'd like to take control of my therapy by having a data capable machine. I went to my doc just last week and he wrote me a script for a new machine (also a new pressure of 7) and wrote for them to speak with me about which machine I want.

DME called me on Friday and wanted to give me the S9 Escape, I said no way, I want something that has the data capabilities. (They don't list everything they offer online so I don't even know what they have available) She told me she'd check my insurance (Aetna) and will get back to me. She told me that my insurance doesn't buy machines, most don't anymore, so it will be a forever rental with some type of maintenance agreement after its paid for. Now to the cost. Since I've met my deductible for this year, they said that I wouldn't owe anything for the rest of the year (3 mos), but once my deductible starts over in 2014 that I have to pay the allowable amount 63.25 for the remaining 7 months. This adds up to be around 442.75. They said it doesn't matter what type of machine I pick, the cost will be the same.

I have no idea if this is normal or even okay what they're doing. I don't want to be an uninformed consumer anymore when it comes to my cpap therapy. I don't have any money for a new machine right now, but I can save up for one. I just don't want them to take advantage of me. Please let me know if I missed something or if you have any insight. Thanks!

[khauser]

Normal? It can be. Smart??

Well what I would do if I were you is head over to a site like cpap.com (they host this site) and look at the Respironics series 60. Resmed machines are great, but so are the PR machines ... and they cost a fair bit less.

If you send an email to the people at cpap.com telling them what you want they'll give you a quote that will amaze you, I think. For the $470-ish you're about to pay you'll find you can just about own the machine outright. The downside is it won't help your deductible.

That's what I did...

[Mgsnorer]

Another option is to send a PM to STL Mark, who has amazing deals on brand new machines. I just bought a fully data capable, auto machine from him, and I am very happy with it.

Best, Maureen

[robysue]

DME called me on Friday and wanted to give me the S9 Escape, I said no way, I want something that has the data capabilities. (They don't list everything they offer online so I don't even know what they have available) She told me she'd check my insurance (Aetna) and will get back to me. She told me that my insurance doesn't buy machines, most don't anymore, so it will be a forever rental with some type of maintenance agreement after its paid for.

Call your insurance company YOURSELF and get the poop directly from them. My guess is that the person at the DME is feeding you a load of horse hoooey.

Now to the cost. Since I've met my deductible for this year, they said that I wouldn't owe anything for the rest of the year (3 mos), but once my deductible starts over in 2014 that I have to pay the allowable amount 63.25 for the remaining 7 months. This adds up to be around 442.75. They said it doesn't matter what type of machine I pick, the cost will be the same.

Again, call your insurance company yourself and ask them some specific questions about exactly how they pay for CPAP equipment.

Mind you, it may take patience to wring the information out of your insurance company. [Getting info out of mine is like trying to wring blood from a turnip.] But you are entitled to know exactly what your insurance company will and will not pay for and you are entitled to get that information from the insurance company directly.

[SleepWellCPAP]

All great suggestions posted so far.

Your pressure fairly low at 7 cm, you could use either the Respironics or ResMed brand and I think you would be happy with the results.

Regarding insurance coverage, I would second the idea about calling your insurance directly. Though it sounds like they are following the standard 10 month capped rental period, I would call to be sure how much and for how long. If you are only $450 out of pocket regardless of machine time, I would just go ahead and ask them for either the S9 Auto (not Escape of course) or the PR Sys One auto. At least you would not have to come up with a lump sum and your supplies would be covered.

Good luck!

[RandyJ]

She told me that my insurance doesn't buy machines, most don't anymore, so it will be a forever rental with some type of maintenance agreement after its paid for.

Whether she is lying to you or not, don't sign up for that. Some of those "maintenance agreements" can have you pay for the machine 20 times over.

You can get the machine you want by buying direct (as indicated above) and save A LOT of money.

[Pugsy]

I think that some Aetna plans have switched to a forever rental with service plan.
A couple of other forum members have mentioned it. After the initial period there is an every 6 month service agreement charge.
Check to make sure that the 6 months I think I remember is correct and I think it was in the neighborhood of $60 or so.
I think DrowsyDancer has same insurance. Haven't seen her around lately.
Check directly with your insurance company as to what they do and pay and what you can expect to pay for that maintenance fee.

[123.Shawn T.W.]

I don't rent ... I just bought it out right ... I got a lightly used one (627 hrs) from SecondWind ...

[jb1654]

Thank you all for the advice so far.

Yes I did call the insurance company to verify what she said. They have changed to a "rent-to-own" system with the patient paying the contracted amount per month for the machine if the deductible hasn't been met. So I would end up paying nothing now, but the 63.25 from Jan-July next year. Also, Aetna mentioned that the DME's bill them for the maintenance every 6 months whether they've done anything to the machines or not. Nice.

So I guess my question is now whether to go with my current DME and get whatever machines they have for no cost now, but $440 in the next year, or save up for a new machine and buy one outright from somewhere online. Cost is certainly a factor as my wife just had a heart attack in June and isn't back to work yet, so we're scrimping by.

Still bugs me that they don't have any type of catalog whether online or physical that I can look at what type of supplies they offer. Thanks everyone for your help.

Side note: Am I the only one who's machine isn't showing up in my equipment profile?

[Pugsy]

Side note: Am I the only one who's machine isn't showing up in my equipment profile?

No, you aren't alone. The equipment links to a lot of the older discontinued equipment seem to be broken. Everything in the equipment menu is tied to cpap.com inventory (cpap.com hosts this forum) and the links to products no longer available there seem to be broken.
Just manually type in your machine model in the comments section like I have my backup machine listed. Then we can see it easily enough.

There is an up side and down side to the perpetual rental with your insurance...the down side is that maintenance fee and the new deductible fees after Jan 1....the upside is ease in getting a newer model machine if they ever come out...at least this is what DrowsyDancer told me that she found out.
Or if yours died after the 2 year warranty was up or whatever. You never own it...you are leasing it.

[jb1654]

There is an up side and down side to the perpetual rental with your insurance...the down side is that maintenance fee and the new deductible fees after Jan 1....the upside is ease in getting a newer model machine if they ever come out...at least this is what DrowsyDancer told me that she found out.
Or if yours died after the 2 year warranty was up or whatever. You never own it...you are leasing it.

That's true. And If the machine itself is around 900, then it is a savings. I'm wondering too if they have the S9 Auto. Do you have to have a script for an auto specifically in order to get one?

[hyperlexis]

Hi everyone, I could really use some help with this situation.

Diagnosed 2008, DME gave me a ResMed S8 Compact. I had Blue Cross Blue Shield, best insurance of my life, never really paid attention. They bought it, so I own it free and clear. After reading this board for awhile, I've decided that I'd like to take control of my therapy by having a data capable machine. I went to my doc just last week and he wrote me a script for a new machine (also a new pressure of 7) and wrote for them to speak with me about which machine I want.

DME called me on Friday and wanted to give me the S9 Escape, I said no way, I want something that has the data capabilities. (They don't list everything they offer online so I don't even know what they have available) She told me she'd check my insurance (Aetna) and will get back to me. She told me that my insurance doesn't buy machines, most don't anymore, so it will be a forever rental with some type of maintenance agreement after its paid for. Now to the cost. Since I've met my deductible for this year, they said that I wouldn't owe anything for the rest of the year (3 mos), but once my deductible starts over in 2014 that I have to pay the allowable amount 63.25 for the remaining 7 months. This adds up to be around 442.75. They said it doesn't matter what type of machine I pick, the cost will be the same.

I have no idea if this is normal or even okay what they're doing. I don't want to be an uninformed consumer anymore when it comes to my cpap therapy. I don't have any money for a new machine right now, but I can save up for one. I just don't want them to take advantage of me. Please let me know if I missed something or if you have any insight. Thanks!

I have never heard of such a thing -- my BCBS charged three, pro-rated months of rental on each piece of equipment, humidifier and blower, and if I was 'compliant' by using it, after three months, they/I could buy the whole thing outright if I wanted -- for 20% of the allowable charge, plus my annual deductible. So if the allowable charge for the machine was $1,000, I would at minimum have to pay $200 + my $500 annual deductible. BCBS also allowed some of the deductible paid in the last two or three months in the prior year to 'roll over' into the year I bought the machine. (Somewhat confusing).

You should find out what they are really talking about. What happens if you simply stop paying the 'rental' fee? Do they repossess the machine? Paying a 'rental' fee in perpetuity is foolish. There must be a cut off date. I cant imagine they will charge you $45 a month, forever. (Although monthly payments could be seen as a payment plan which could help spread the cost, as long as its a 'rent to own' deal). The machines are only valued near or under $1,000 by the insurance companies. I cant remember my exact negotiated price but I think it was near $800 or so. So I paid around $300 - 400 in real dollars with all the fees and co-pays, deductibles, mask costs, etc. at the end of the day. Still cheaper than buying online, plus helped satisfy my deductible for the year anyway.

You should ask for greater clarification from the insurance company and DME: 1) What is the exact contracted price for the equipment based on the billing code for a CPAP/APAP + mask. 2.) What is your out of pocked cost; and 3.) Is it a rent to own deal or perpetual 'rental'...

[Pugsy]

Do you have to have a script for an auto specifically in order to get one?

Technically no...all that is required technically is cpap RX. Remember an Auto (APAP) machine is just a cpap machine with auto adjusting pressure mode and it also has a cpap mode.

Some DMEs like to play hardball and will tell you that they can't do it but technically they could if they just would...cpap machine RX will get you a machine that has APAP mode....cpap.com does it along with every other online seller out there that needs a RX on file.
Now if you wanted a bilevel pressure machine...that's a different story and cpap RX won't let you buy a bilevel machine online.
That's how come I have to get my bilevel machines on the gray market.

When we suggest that a patient have the doctor write script for APAP machine or pressure ranges it is because then the DME can't dig their heels in and be difficult about it. Avoid the hassles.

[oak]

Yes I did call the insurance company to verify what she said. They have changed to a "rent-to-own" system with the patient paying the contracted amount per month for the machine if the deductible hasn't been met. So I would end up paying nothing now, but the 63.25 from Jan-July next year. Also, Aetna mentioned that the DME's bill them for the maintenance every 6 months whether they've done anything to the machines or not. Nice.

So I guess my question is now whether to go with my current DME and get whatever machines they have for no cost now, but $440 in the next year, or save up for a new machine and buy one outright from somewhere online.

It sounds to me like you already did your homework with the insurance company and got your answer-its rent to own and you would not have the monthly payments until next year. I would make sure all of this is clearly in writing if you choose to go the DME route, of course. If the DME goes out of business, though (as many have been doing) be sure you know how this will work. If the DME does not give you the machine you want, DONT ACCEPT IT. Just walk out the door and take your business elsewhere. I cant emphasize this enough. Many DME's have been known to become very cooperative when the patient asserts self.

You do have the advantage of having a local provider for accessories and supplies, like filters, mask parts, etc. with the plan above, for what that is worth. Some DME's are great, and others terrible, as you probably know already.

Good luck!