Buying from a DME vs cpap.com

[chunkyfrog]

Registry is anonymous, so it doesn't matter.
What DME pays for YOUR support?

[iamknowntoo]

he or she is as known as you are
and was only sharing an experience
isnt that what forums are for?

[D.H.]

Unless insurance is paying for it, there' almost never a reason to buy from a DME. Also, don't limit yourself to CPAP.COM, shop around at other on-line vendors including (but not limited to) Amazon & Ebay.

A little anecdote here. I needed to replace my (then) six-year old CPAP machine in 2005. After getting an estimate from a DME, the cost would be approx. $1500, and they'd decide which machine I would get. At that time, it was possible that I would be send a machine with a "stand-alone" humidifier that was not compatible with intentional voltage. My insurance would cover 90% of the cost. An on-line vendor would me the machine I wanted for $500; of which the insurance would pay a 70% out-of-network benefit. Thus, it was, in effect, the same price. I got the machine I wanted and I didn't have to deal with that annoying DME. Of course, it came UPS rather than being delivered by the DME, but I wasn't interested in that anyhow.

A DME will almost never cost less out-of-pocket unless insurance is paying for it!

[Texascats]

I'm on Medicare and the rules make it hard to deal with a DME supplier. No supplemental insurance.

Before I bought from cpap.com I researched to determine time to get equipment, cost, and flexibility of choice. Medicare kept wanting more and more data then I learned I couldn't get the machine I wanted. Also I had to rent, despite being on CPAP for over 20 years. Who says ACH works, and now they want to put everyone on Medicare to provide one-payer system.

Glad I saved my money.

[chunkyfrog]

My current machine was paid for 100% by my Medicare A and B.
If you got sucked in by Medicare "advantage", too bad.
I bring my card in once a year to the sleep doc.
They print out the Rescan data. No problem.

[BrianinTN]

Hi old friends! It's been a while. I realize this is an older thread, but my question is on exactly this topic, so it seemed better to post here rather than start a new topic. (If I'm wrong, someone let me know and I will start a new one.)

My sister recently joined our ranks as a to-be CPAP user. She's in the middle of the insurance-doctor-DME dance. Unfortunately, she has to decide on her 2018 Flexible Savings Account amount by Friday--and the DME doesn't have its act together, so she's flying blind.

Does anyone have any rough idea how much a CPAP (I assume a Dreamstation these days?) is "valued" at through insurance (in her case, Aetna)? And a mask (probably the AirFit P10)? With some rough numbers, I can back out her deductible and coinsurance to figure out how much she should allocate to her Flex plan.

Thanks so much!

[chunkyfrog]

Hi old friends! It's been a while. I realize this is an older thread, but my question is on exactly this topic, so it seemed better to post here rather than start a new topic. (If I'm wrong, someone let me know and I will start a new one.)

My sister recently joined our ranks as a to-be CPAP user. She's in the middle of the insurance-doctor-DME dance. Unfortunately, she has to decide on her 2018 Flexible Savings Account amount by Friday--and the DME doesn't have its act together, so she's flying blind.

Does anyone have any rough idea how much a CPAP (I assume a Dreamstation these days?) is "valued" at through insurance (in her case, Aetna)? And a mask (probably the AirFit P10)? With some rough numbers, I can back out her deductible and coinsurance to figure out how much she should allocate to her Flex plan.

Thanks so much!

Since your question is the only one from THIS YEAR, I would like to address YOUR question:
Check cpap.com for prices of acceptable machines.
Even if insurance kicks in for a machine, it is wisest to always have a backup machine, masks, etc.,
because bad stuff always happens on the weekend.
If her FSA covers glasses, dental copays, etc, figure that in, too. Good luck.

[ChicagoGranny]

Hi old friends! It's been a while. I realize this is an older thread, but my question is on exactly this topic, so it seemed better to post here rather than start a new topic. (If I'm wrong, someone let me know and I will start a new one.)

My sister recently joined our ranks as a to-be CPAP user. She's in the middle of the insurance-doctor-DME dance. Unfortunately, she has to decide on her 2018 Flexible Savings Account amount by Friday--and the DME doesn't have its act together, so she's flying blind.

Does anyone have any rough idea how much a CPAP (I assume a Dreamstation these days?) is "valued" at through insurance (in her case, Aetna)? And a mask (probably the AirFit P10)? With some rough numbers, I can back out her deductible and coinsurance to figure out how much she should allocate to her Flex plan.

Thanks so much!

She should be asking her insurance company what her part of a CPAP machine cost is. The DME is the wrong place to ask.

[Janknitz]

DMEs often cannot tell you your out of pocket costs for an item because it’s not like a retail store with a fixed price. They have a contractual agreement with each insurer (and sometimes with multiple plans with the same insurer to only collect from you a percentage (typically 20%) of the insurer’s allowable amount. Two people with different plans can pay very different prices for the same item. And then they don’t know if youve met your deductible yet, which makes a difference, too.

So they are more being lazy than BSing when they can’t tell you your cost.

[ChicagoGranny]

Buying from a DME vs cpap.com

Is anyone else struck funny by this title?

cpap.com is a DME.

[BrianinTN]

DMEs often cannot tell you your out of pocket costs for an item because it’s not like a retail store with a fixed price. They have a contractual agreement with each insurer (and sometimes with multiple plans with the same insurer to only collect from you a percentage (typically 20%) of the insurer’s allowable amount. Two people with different plans can pay very different prices for the same item. And then they don’t know if youve met your deductible yet, which makes a difference, too.

So they are more being lazy than BSing when they can’t tell you your cost.

Yup, exactly, and this gets to the heart of what I was trying to ask—which is (roughly) what the typical contracted and negotiated rate for a CPAP is. Specifically, before deductibles, coinsurance, etc.

My assumption was that this "cost" can differ substantially from what the retail pricing of purchasing an item outright is say from cpap.com. If you look at an EOB for a medical service, for example, you'll see an inflated "billed" cost, and then an insurance "adjusted" cost for that particular CPT code, which is the negotiated rate. And then you see what you owe based on your deductible/coinsurance/copayment numbers.

So that's kind of what I am trying to assess here: what that negotiated/"adjusted"/covered cost looks like these days for an auto CPAP. It might be higher than what's listed for products on cpap.com, or it could be lower. I have no idea, hence my question. A call to Aetna would only tell her her benefits (e.g., 15% coinsurance after a $300 deductible), which she already knows.

Hope this makes more sense this time around!

[Pugsy]

A call to Aetna would only tell her her benefits (e.g., 15% coinsurance after a $300 deductible), which she already knows.

Can Aetna not give you an amount for a specific HCPCS billing code?
Like call them up and ask how much do you allow for this specific cpap billing code...and for a regular cpap/apap machine it is E0601.
They have this amount in their system...now them doing the necessary "work" to find it is often a different matter.

[ChicagoGranny]

Can Aetna not give you an amount for a specific HCPCS billing code?
Like call them up and ask how much do you allow for this specific cpap billing code...and for a regular cpap/apap machine it is E0601.
They have this amount in their system...now them doing the necessary "work" to find it is often a different matter.

+1

Yes, given the HCPCS code, Aetna can look up an individual's policy and tell that individual how much Aetna pays, how much the patient pays, how the deductible and out-of-pocket limits affect the transaction and which DMEs are in the network. Just call them.

[BrianinTN]

A call to Aetna would only tell her her benefits (e.g., 15% coinsurance after a $300 deductible), which she already knows.

Can Aetna not give you an amount for a specific HCPCS billing code?
Like call them up and ask how much do you allow for this specific cpap billing code...and for a regular cpap/apap machine it is E0601.
They have this amount in their system...now them doing the necessary "work" to find it is often a different matter.

Haha, so true! We actually did try this two weeks ago, but perhaps it's worth another shot. Maybe we'll get someone more helpful on the phone.