Ok. Os am I ever frustrated with my insurance company and I'm not sure what to do. I was able to convince my Dr. to write me a prescription for the new M series Pro machine from Respironics so I utilize the additional recorded data that it provides. Well after a battle with the DME to convince them to order the machine for me, I come to find out that the insuance won't pay for the difference in cost of the machines because they state they need a letter of medical neccesity from my Dr. This really irks me because I didn't have a say in what machine I get to begin with when I first went to see my DME. I know I could go to cpap.com and order it on my own, but I'm not in the position to do that financially and besides, my insurance covers me 100% all around. Yes I could try to go through billmyinsurance.com, but I have a feeling I'd run into the same thing where they would need a letter of medical neccesity from my Dr. I've been cpap'ing it now for about 6 weeks and I don't feel that I still should be where I would think I should be or want to be after 6 weeks of therapy. I undertand that since I suffered with OSA for years beforehand, my body will need time to adjust. It has, but again, I just don't think I'm where I should be. I know I could get where I need to be because I've learned so much from all of the wonderful people on these boards; but only if I had a way to view my AHI, snore index, etc. and make adjustments where needed. And yes I could go through the painful process of taking the smartcard to the Dr./DME, but really don't have the time or money (Dr.'s Co-Pays) to be doing that. So with all of this said, does anyone have any ideas?
Frustrated with Insurance Company - I need help !!!!
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Guest
I went through the same thing when I was needing a new mask before my 6 months was up. My insurance only pays for 1 ever 6 months but I was having a problem with a lot of leaks with the comfortgel mask I had started usign. I asked the billing girl at my companies office about it and she told me that the letter of neccesaty thing is what allows them to bill an insurance company for something that doesn't have a code or isn't covered. After goign around for a while with my docs office, they finally sent it and it ended up being covred. I just had to tell the doc exactly what it needed to say.
I would guess that your company is wanting the letter to see if your insurance will cover the higher priced unit. Alot of people here have said there is only 1 amount paid for all differnet machines. This is what cpap.com says "This is because there is only one billing code for all CPAP Machines and very few unique codes for CPAP Masks. Due to this, the insurance company will pay your CPAP Provider the same amount if you get a high end or basic machine. Usually, the amount paid to traditional CPAP Providers by insurance companies is not enough to cover the cost of high end CPAP equipment"
I would guess that your company is wanting the letter to see if your insurance will cover the higher priced unit. Alot of people here have said there is only 1 amount paid for all differnet machines. This is what cpap.com says "This is because there is only one billing code for all CPAP Machines and very few unique codes for CPAP Masks. Due to this, the insurance company will pay your CPAP Provider the same amount if you get a high end or basic machine. Usually, the amount paid to traditional CPAP Providers by insurance companies is not enough to cover the cost of high end CPAP equipment"
It is true that there is only one billable code for Cpap and Two Billable codes for BIPAP. However I am sure that the reimbursement from insurance companies covers the cost of the higher end equipment. I worked in a physician's office long before I got into the DME arena and I spent many years fighting with the DME companies to give our patients the equipment they deserved. (And the equipment that the physician ordered) The physician I worked for always ordered downloadable machines or Auto PAP machines for his patients and certain DME companies would call and try to talk us into changing the script so that they could make more money. So I know all about Evil DME companies. My stand then, and my stand now that I work at a DME company is that the cost on the DME end of CPAP vs APAP is not worth a patient suffering because the DME company wanted to make a buck. I know from my stand point I did not go into the medical field to make a quick buck, I became an RT to help people feel better. I can't do that with sub-standard equipment. You are a patient as well as a customer when you come into a DME company. It is really sad that the DME market is the way it is. The bigger companies are able to take over by offering sub-standard equipment and service and make everyone look bad.
Jack, about the only thing I can suggest is that maybe your doctor will write you a new prescription for an Auto - Remstar Auto with cflex (the current version). Since you are not feeling good with your current machine, perhaps an Auto (with it's adjustable pressures) would provide you with better treatment.
Then, your insurance company would have what it needs to buy you a new machine.
Then, your insurance company would have what it needs to buy you a new machine.
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
I can't say that I have any major ideas but since you wanted responses I will put in my two cents.
Letter of Medical necessity didn't do a thing for me. Insurance and DME (at first) still refused to provide my Auto. Insurance held the line to the bitter end calling an Auto a "deluxe machine". It seems that your insurance is calling a Pro 2 or something that gives you data a Deluxe machine. Hard to fight what the insurance co doctor says is standard care. My insurance goes to an outside 3rd party on the 3rd level of appeal. Might do better there but who really knows.
I did not originally go home with "any old machine that the DME decided to give me". I think that helped me. I decided to fight the fight before I got committed to something. I picked up a used machine for the duration of the fight through Ebay. Obviously this doesn't help you, unless you want to go without therapy and throw the machine you have back at them and look for something cheap while you fight, and you still may lose.
I firmly believe that once you take something you lose some leverage in bargining. Others have been successful with the "Take what they give you and then complain that it doesn't work for me I need a different machine approach". I can't say which approach is best. Doesn't really matter because you don't have my approach as an option since you have their Plus in your house.
Where I won was that the DME caved (wasn't on the first phone call nor was it the second). On the billing code thing, that is where the insurance company really doesn't matter. They don't know what they are paying for. Same price for any CPAP (E0601 code) unless someone really digs into the name of the machine.... which I would doubt. So that gives you another way to get the better machine that you want . Work on the DME. Find a sympathetic ear there with multiple phone calls to them. In short try being a pain. Really sad one has to do this to get data collection capability. May be easier to shut you up by giving you what you want. BUT since you took the first one I don't know how much leverage you will have unless you threaten (and are willing to actually do it) to give them back a used machine and walk out. Might work, might not too since either way (if they accomidate you or not, they still have a used plus machine to deal with which has to cost them something to dispose of). That is why I think one has a better chance before taking something out of their office/store.
What I just can't understand, why they want to trade equiptment rather than give you what you want the first time and be done with it. Has to be cheaper than a bunch of unwanted Plus machines being returned, unless they manage to palm them off on some other customer who doesn't know that they are getting a used machine.
Linda says that if you doc provides you a new prescription for an auto then your insurance co would have what it needs to buy you a new machine.
I DISAGREE. Didn't work for me. Very stubborn Insurance. They have their doctor who will decide what standard of care you should have. He may decide that your doc is right but as in my case he didn't and denied the auto. I firmly believe that he didn't do anyting but rubber stamp it NO. No problem to try though. Just don't assume that you will get it because you have a prescription.
As I said, I really don't have too many ideas other than get the letter of medical necessity and go up the Insurance company appeals ladder (mine was 3 levels of appeal) and/or work on the DME either by calling, calling or being ready to dump them. With your insurance being 100% dumping them costs you a bit if you can't go somewhere else. I don't know if they would have to take you back in the future if you decided the plus was ok.
Good luck whatever you do.
Letter of Medical necessity didn't do a thing for me. Insurance and DME (at first) still refused to provide my Auto. Insurance held the line to the bitter end calling an Auto a "deluxe machine". It seems that your insurance is calling a Pro 2 or something that gives you data a Deluxe machine. Hard to fight what the insurance co doctor says is standard care. My insurance goes to an outside 3rd party on the 3rd level of appeal. Might do better there but who really knows.
I did not originally go home with "any old machine that the DME decided to give me". I think that helped me. I decided to fight the fight before I got committed to something. I picked up a used machine for the duration of the fight through Ebay. Obviously this doesn't help you, unless you want to go without therapy and throw the machine you have back at them and look for something cheap while you fight, and you still may lose.
I firmly believe that once you take something you lose some leverage in bargining. Others have been successful with the "Take what they give you and then complain that it doesn't work for me I need a different machine approach". I can't say which approach is best. Doesn't really matter because you don't have my approach as an option since you have their Plus in your house.
Where I won was that the DME caved (wasn't on the first phone call nor was it the second). On the billing code thing, that is where the insurance company really doesn't matter. They don't know what they are paying for. Same price for any CPAP (E0601 code) unless someone really digs into the name of the machine.... which I would doubt. So that gives you another way to get the better machine that you want . Work on the DME. Find a sympathetic ear there with multiple phone calls to them. In short try being a pain. Really sad one has to do this to get data collection capability. May be easier to shut you up by giving you what you want. BUT since you took the first one I don't know how much leverage you will have unless you threaten (and are willing to actually do it) to give them back a used machine and walk out. Might work, might not too since either way (if they accomidate you or not, they still have a used plus machine to deal with which has to cost them something to dispose of). That is why I think one has a better chance before taking something out of their office/store.
What I just can't understand, why they want to trade equiptment rather than give you what you want the first time and be done with it. Has to be cheaper than a bunch of unwanted Plus machines being returned, unless they manage to palm them off on some other customer who doesn't know that they are getting a used machine.
Linda says that if you doc provides you a new prescription for an auto then your insurance co would have what it needs to buy you a new machine.
I DISAGREE. Didn't work for me. Very stubborn Insurance. They have their doctor who will decide what standard of care you should have. He may decide that your doc is right but as in my case he didn't and denied the auto. I firmly believe that he didn't do anyting but rubber stamp it NO. No problem to try though. Just don't assume that you will get it because you have a prescription.
As I said, I really don't have too many ideas other than get the letter of medical necessity and go up the Insurance company appeals ladder (mine was 3 levels of appeal) and/or work on the DME either by calling, calling or being ready to dump them. With your insurance being 100% dumping them costs you a bit if you can't go somewhere else. I don't know if they would have to take you back in the future if you decided the plus was ok.
Good luck whatever you do.
Similar Situation
Snoregirl,
Only by chance, and gratefully before the claims were completely rejected, did I discover that my insurance company needed a letter of medical necessity before they would cover ANY of my CPAP needs, including machine, mask, tubing, replacement filters, etc. The billing person at my DME was the one who suggested my doctor write a letter stating that all CPAP supplies were medically necessary. She directed him to fax it to her at the DME, she kept a copy on file and sent one to my insurance. Now everything is being covered to the full extent of my policy with no further questions asked.
While it's a pain to have to request the letter from your doctor and make certain that he actually writes it, it shouldn't be a hardship or an inconvenience for him to do so -- just more paperwork created by the insurance companies.
Keep up the good fight! We're all here to support you!
Kurtchan
Only by chance, and gratefully before the claims were completely rejected, did I discover that my insurance company needed a letter of medical necessity before they would cover ANY of my CPAP needs, including machine, mask, tubing, replacement filters, etc. The billing person at my DME was the one who suggested my doctor write a letter stating that all CPAP supplies were medically necessary. She directed him to fax it to her at the DME, she kept a copy on file and sent one to my insurance. Now everything is being covered to the full extent of my policy with no further questions asked.
While it's a pain to have to request the letter from your doctor and make certain that he actually writes it, it shouldn't be a hardship or an inconvenience for him to do so -- just more paperwork created by the insurance companies.
Keep up the good fight! We're all here to support you!
Kurtchan
Kurtchan,
I am not sure, but maybe you misunderstood me.
I HAVE a letter of medical necessity for the machine and accessories that I wanted and the insurance company STILL decided that I didn't need that machine.
All I am trying to say is that just because you do all this stuf, and in my case go through 3 seperate rounds of appeals, no one can say that "THE DME AND INSURANCE WILL HAVE TO GIVE IT TO YOU" The bottom lline is they don't have to. Maybe if you sue, but I am not an attorney so I really don't know the answer to that one.
They may give it to you, but they don't HAVE TO.
Absolutisms are dangerous.
I am certainly not advocating not getting all the paperwork, letter of medical necessity, detailed prescription etc. Just that that still may not be enough. And if it is, there may be other ways before you totally give up. I am living proof of that. And that was my interpretation of what Cpapjack was looking for in his post that started this thread. Ideas if all else fails.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): DME, Prescription
I am not sure, but maybe you misunderstood me.
I HAVE a letter of medical necessity for the machine and accessories that I wanted and the insurance company STILL decided that I didn't need that machine.
All I am trying to say is that just because you do all this stuf, and in my case go through 3 seperate rounds of appeals, no one can say that "THE DME AND INSURANCE WILL HAVE TO GIVE IT TO YOU" The bottom lline is they don't have to. Maybe if you sue, but I am not an attorney so I really don't know the answer to that one.
They may give it to you, but they don't HAVE TO.
Absolutisms are dangerous.
I am certainly not advocating not getting all the paperwork, letter of medical necessity, detailed prescription etc. Just that that still may not be enough. And if it is, there may be other ways before you totally give up. I am living proof of that. And that was my interpretation of what Cpapjack was looking for in his post that started this thread. Ideas if all else fails.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): DME, Prescription
First of all, I'd like to thanks everyone for their replies. All together, I definitely have more insight now on how to get what it is I want. I called my Dr. this morning from a follow up appointment I had two weeks ago and talked to him about APAP machines. I think I've decided this is the way I want to go, not only for the recorded data, but for the advantages of an APAP. I'm one who change positions alot, so it appears that this may help in that area. Anyway, my Dr. wrote me a script for a 1 week trial of an APAP machine. He will then review the results to see if it really makes a difference, which that scares me a bit, knowing that he might say that it didn't and that I don't need an APAP. I'll worry about that then. At least I'm a step closser to getting what I feel I need and want.
Okay. That's a good start.
Now, make sure the DME narrows the parameters of the Auto. If he doesn't, then you might feel suffocated at a low of 4. Plus, the auto might run away with you if you have a major leak and it keeps bumping itself up higher. The ideal setting would be 6 to 12, IMO.
If left wide open, you might get some really messed up reports, and/or feel crappy.
Now, make sure the DME narrows the parameters of the Auto. If he doesn't, then you might feel suffocated at a low of 4. Plus, the auto might run away with you if you have a major leak and it keeps bumping itself up higher. The ideal setting would be 6 to 12, IMO.
If left wide open, you might get some really messed up reports, and/or feel crappy.
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
OSA Insurance: BlueCross CA
Hi cpapjack-
I too am new to the cpap business and walked away today from a meeting with APRIA's Respitory Therapist (RT) without accepting the equipment offered when she presented me a basic REMstar Plus without humidifier. She explained that this is all my insurance would cover, but as you've probably learned from others by now, there is only one insurance code for a CPAP machine, so I expect APRIA is working their profit margin to the max by offering me the least expensive option available.
I have BlueCross of CA, and they have pretty clear policies regarding the treatment of OSA:
http://medpolicy.bluecrossca.com/policies/MED/OSA.html
APAP is only considered medically necessary by BlueCross if your sleep study indicated a pressure of at least 10 cm H2O and you cannot tolerate the pressure you are prescribed with CPAP. My guess is that most insurance companies are following this policy, so you and your Dr. would need to meet both criteria to get APAP.
Notice that the BlueCross policy will not pay for Respironic's c-flex machines; they are considered to be investigational and to have insufficient research to support their use over conventional xPAP machines.
The BlueCross OSA treatment policy doesn't say anything about the medical necessary conditions for a humidifier, but the APRIA RT explained that I needed to be on CPAP for 30 days without humidifier, file multiple complaints with my doctor during that time period (probably needs to be the first 30 days of use), and then apply for a humidifier. APRIA's own website and literature never mention the use of a humidifer to treat dry nose, mouth, etc. In fact, their literature that I saw today suggested that I'd get use to it after 4-weeks (hence my suspection that problems need to be documented during the first month of use to have a chance of obtaining one).
I'm going to consult with my Dr. tomorrow, but have pretty much decided to purchase equipment on my own. I am not now eligible for APAP, as my pressure setting from my sleep study was 8. From what I've read in the cpaptalk.com forum, APAP is considered more useful to deal with variations in sleep position, weight change, and diet, whereas varying the air pressure during exhalation (c-flex) is helpful with higher pressures. I'm not sure why BlueCross doesn't make APAP available to new users; I want it because I expect to need my pressure titrated as I begin treatment and have seen others in the forum talk about how their APAP pressures changed over time and during a single night as they moved sleeping positions.
I also want to be able to monitor my progress and need software to give me some information about how well I am doing, making sure the mask is working right, etc. Once again, there is no BlueCross policy that pertains to monitoring capabilities of the machine, so APRIA's statement to me that I have no insurance coverage is probably related to their profit margin on the machine again or the fact that all xPAP machines I've looked at that can use software are APAP machines.
I'm very interested in how things work out for you. I'd suggest talking to your insurance company and obtaining a copy of their OSA treatment policy. It may help you and your Dr. say the right things to meet medical necessity criteria.
Good Luck.
-Chris
I too am new to the cpap business and walked away today from a meeting with APRIA's Respitory Therapist (RT) without accepting the equipment offered when she presented me a basic REMstar Plus without humidifier. She explained that this is all my insurance would cover, but as you've probably learned from others by now, there is only one insurance code for a CPAP machine, so I expect APRIA is working their profit margin to the max by offering me the least expensive option available.
I have BlueCross of CA, and they have pretty clear policies regarding the treatment of OSA:
http://medpolicy.bluecrossca.com/policies/MED/OSA.html
APAP is only considered medically necessary by BlueCross if your sleep study indicated a pressure of at least 10 cm H2O and you cannot tolerate the pressure you are prescribed with CPAP. My guess is that most insurance companies are following this policy, so you and your Dr. would need to meet both criteria to get APAP.
Notice that the BlueCross policy will not pay for Respironic's c-flex machines; they are considered to be investigational and to have insufficient research to support their use over conventional xPAP machines.
The BlueCross OSA treatment policy doesn't say anything about the medical necessary conditions for a humidifier, but the APRIA RT explained that I needed to be on CPAP for 30 days without humidifier, file multiple complaints with my doctor during that time period (probably needs to be the first 30 days of use), and then apply for a humidifier. APRIA's own website and literature never mention the use of a humidifer to treat dry nose, mouth, etc. In fact, their literature that I saw today suggested that I'd get use to it after 4-weeks (hence my suspection that problems need to be documented during the first month of use to have a chance of obtaining one).
I'm going to consult with my Dr. tomorrow, but have pretty much decided to purchase equipment on my own. I am not now eligible for APAP, as my pressure setting from my sleep study was 8. From what I've read in the cpaptalk.com forum, APAP is considered more useful to deal with variations in sleep position, weight change, and diet, whereas varying the air pressure during exhalation (c-flex) is helpful with higher pressures. I'm not sure why BlueCross doesn't make APAP available to new users; I want it because I expect to need my pressure titrated as I begin treatment and have seen others in the forum talk about how their APAP pressures changed over time and during a single night as they moved sleeping positions.
I also want to be able to monitor my progress and need software to give me some information about how well I am doing, making sure the mask is working right, etc. Once again, there is no BlueCross policy that pertains to monitoring capabilities of the machine, so APRIA's statement to me that I have no insurance coverage is probably related to their profit margin on the machine again or the fact that all xPAP machines I've looked at that can use software are APAP machines.
I'm very interested in how things work out for you. I'd suggest talking to your insurance company and obtaining a copy of their OSA treatment policy. It may help you and your Dr. say the right things to meet medical necessity criteria.
Good Luck.
-Chris
Chris, sounds like a good plan, especially if you can afford to buy the machine you want. Make sure you get your prescription from the RT. And cpap.com doesn't need the prescription to say anything about the humidifier.
Now, depending on what percentage your co-pay is, you might want to still get a machine and the mask of your choice through the DME. Get the best machine they will allow, (say a Remstar) -- then at least you will have a back-up unit if you buy a Remstar Auto with cflex. Or, you can sell the cheaper machine to help offset your out of pocket costs. Lots of people will buy a new inexpensive machine if they have no insurance. So you wouldn't have any trouble selling it.
Now, depending on what percentage your co-pay is, you might want to still get a machine and the mask of your choice through the DME. Get the best machine they will allow, (say a Remstar) -- then at least you will have a back-up unit if you buy a Remstar Auto with cflex. Or, you can sell the cheaper machine to help offset your out of pocket costs. Lots of people will buy a new inexpensive machine if they have no insurance. So you wouldn't have any trouble selling it.
_________________
| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
It's how the game is played...
don't even bother, you are wasting your time. you think you are the very FIRST patient to ever attempt this? From the looks of that avatar, I better explain it to you:
The only way you can get an autopap and have insurance pay for it is by having a doctor and DME that fully cooperates with you in making that happen. the insurance billcode for the autopap is the same as it is for cpap. If you have that ripoff Apria DME forget about it.
Just take the issued machine, but DEMAND that it be a brand spanking new machine in original carton with heated humidifier (if it is a Remstar, get the Remstar integrated humidifier not some adjunct universal one like a F&P 150), make sure you get the original box (there is no way to sanitize a used machine, so refuse to accept one). If your doctor did NOT put down a heated humidifier go back and get it on the script.
Select and make them order and pay for the most expensive mask available (I suggest a Resmed UltraMirage Full Face, make them order it even if they don't stock it, don't accept Respironics version, not as good, so except NO excuses). You will always need a FF mask as backup when you get a cold and/or start mouth breathing. You want a different mask you think is better? then buy the cheaper ones yourself on-line directly (you don't need a script for a mask, that is ONLY a insurance requirement). Let insurance pay for the expensive items, you buy the cheaper ones. What you pay for, you keep the receipts and write it off your taxes under medical.
Take the insurance issued machine and sell it on craigslist or yahoo or at a flea market. Then take the proceeds and go on-line and purchase the machine of your choice from cpap.com (you need a copy of your script). Then in about 10 months your insurance will call you up and ask if you are still using that machine? if you say yes, they will then purchase it from the national DME without telling you, but they will let you know your stuck with that machine now for 5-years (got a used machine? another reason to only accept a brand spanking new machine). Your insurance will NOT pay for another machine for 5 years??. You accepted a used machine? Did they lower your premiums by giving you a used machine instead of new? Don't think so, demand new.
It's really all a game, it's a racket, it's a rip-off, it's a legal license to steal from you the patient. It's an investor's heaven, like futures on gasoline, it is how the game gets played.
You are paying the premiums weather you use it or not, and you have absolutely no say over it, so why stress out about it, I say screw the insurance company and these national DME's, some day them idiot insurance companies will wake up, but as long as they allow them to charge any premium they want, we are going to have to live with this mess, so take advantage of it.
Summary:
1-demand brand new equipment from insurance & contract DME.
2-let insurance pay for the expensive items, you pay for the cheaper ones.
3-obtain copies of your PSG, prescription etc., you'll need it in the future.
4-sell your insurance issued equipment on-line.
5-use the proceeds to buy the machine or autopap of your choice on-line.
6-screw the insurance and national DME's, they deserve it and created this mess on their own for being money whores.
7-take control of your own therapy and save some money in the process.
I didn't create it, but it's how the game is played...
The only way you can get an autopap and have insurance pay for it is by having a doctor and DME that fully cooperates with you in making that happen. the insurance billcode for the autopap is the same as it is for cpap. If you have that ripoff Apria DME forget about it.
Just take the issued machine, but DEMAND that it be a brand spanking new machine in original carton with heated humidifier (if it is a Remstar, get the Remstar integrated humidifier not some adjunct universal one like a F&P 150), make sure you get the original box (there is no way to sanitize a used machine, so refuse to accept one). If your doctor did NOT put down a heated humidifier go back and get it on the script.
Select and make them order and pay for the most expensive mask available (I suggest a Resmed UltraMirage Full Face, make them order it even if they don't stock it, don't accept Respironics version, not as good, so except NO excuses). You will always need a FF mask as backup when you get a cold and/or start mouth breathing. You want a different mask you think is better? then buy the cheaper ones yourself on-line directly (you don't need a script for a mask, that is ONLY a insurance requirement). Let insurance pay for the expensive items, you buy the cheaper ones. What you pay for, you keep the receipts and write it off your taxes under medical.
Take the insurance issued machine and sell it on craigslist or yahoo or at a flea market. Then take the proceeds and go on-line and purchase the machine of your choice from cpap.com (you need a copy of your script). Then in about 10 months your insurance will call you up and ask if you are still using that machine? if you say yes, they will then purchase it from the national DME without telling you, but they will let you know your stuck with that machine now for 5-years (got a used machine? another reason to only accept a brand spanking new machine). Your insurance will NOT pay for another machine for 5 years??. You accepted a used machine? Did they lower your premiums by giving you a used machine instead of new? Don't think so, demand new.
It's really all a game, it's a racket, it's a rip-off, it's a legal license to steal from you the patient. It's an investor's heaven, like futures on gasoline, it is how the game gets played.
You are paying the premiums weather you use it or not, and you have absolutely no say over it, so why stress out about it, I say screw the insurance company and these national DME's, some day them idiot insurance companies will wake up, but as long as they allow them to charge any premium they want, we are going to have to live with this mess, so take advantage of it.
Summary:
1-demand brand new equipment from insurance & contract DME.
2-let insurance pay for the expensive items, you pay for the cheaper ones.
3-obtain copies of your PSG, prescription etc., you'll need it in the future.
4-sell your insurance issued equipment on-line.
5-use the proceeds to buy the machine or autopap of your choice on-line.
6-screw the insurance and national DME's, they deserve it and created this mess on their own for being money whores.
7-take control of your own therapy and save some money in the process.
I didn't create it, but it's how the game is played...