Newbie and Insurance ?

Hello All
I have a couple of quick questions
I have a high deductible insurance ($2500.000) When I look at cpap.com I find machines that can be had in the $800 and up price range. My question is because of the high deductible does it make more sense to just go out of network and pay out of pocket or probably pay more at the insurance co's DME?
Same questions about the masks and accessories?
What kind of help do you get with the online services? Ie: setup help, mask fitting?

I don't have my results yet but the Dr has told me that I will need a CPAP machine.
I am sure I will be back here often with more questions.
Thanks,

The advantage of using a DME under your insurance is if you end up paying more this year than the deductible.

In my case, this year the deductible is $800 and I know I will blow through that long before the year is over. After it is paid (out of my pocket) then any additional payments by me will just be the 20% unless I reach the max out of pocket expenses. So if I had to buy a new machine, it would be worth going through the insurance since I am already going to have that out of pocket anyway.

I reached both last year and had no deductibles or co-pays from about June on last year.

If you don't think you will ever get close to the deductible for the year, you need to weigh the costs of what the DME with your insurance will bill for the equipment and what you can get the same equipment for from other sources.

I have not used CPAP.COM to buy a machine, but I have had very good service with them for items that I have purchased from them.

You need to check whether you can get the CONTRACTED price for your machine and masks through a DME contracted with your insurer. Then, even if you pay it all out of pocket, the price you actually pay may be equal to or even less than buying it yourself on CPAP.com. However, it is sometimes difficult to find out and you have to jump through stupid hoops with the DME to get the equipment you want. The fact that you can get what YOU want for a reasonable price through CPAP.com without the hassle is sometimes worth a lot.

And, as Krelvin points out, if you are already in to your deductible from the sleep study, it may make sense to pay down the deductible for the year since there are still 5 months left.

I'd find an in network DME provider, and get the contracted price thru your insurance. Apply it to your deductible. Ask your insurance co. what the Contracted Price of the machine will be. You will not have to pay the DME full price if your go In Network and use your insurance.

Sometimes the contracted price is close to online vendors. FYI.
One advantage of buying your first machine locally, the vendor should be able to handle warranty service in house,
and should provide a loaner, if needed, for free. Ask them if that is the case.

WDisneynut wrote:Hello All
I have a couple of quick questions
I have a high deductible insurance ($2500.000) When I look at cpap.com I find machines that can be had in the $800 and up price range. My question is because of the high deductible does it make more sense to just go out of network and pay out of pocket or probably pay more at the insurance co's DME?
Same questions about the masks and accessories?
What kind of help do you get with the online services? Ie: setup help, mask fitting?

I don't have my results yet but the Dr has told me that I will need a CPAP machine.
I am sure I will be back here often with more questions.
Thanks,

Do lots of reading here on the forum.
"Do the math".
Keep asking questions.

I bypassed the local DMEs and ordered all of my initial equipment from CPAP.COM and then billed my insurance provider because they considered me to be "in-network" and reimbursed me at the 80% rate. But, I discussed it with them before I did it that way (even though I was prepared to go totally out-of-pocket as I wanted to avoid the local DMEs).
Online providers will be out-of-network, but it depends on how they classify YOU.


Den

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WDisneynut wrote:Hello All
I have a couple of quick questions
I have a high deductible insurance ($2500.000) When I look at cpap.com I find machines that can be had in the $800 and up price range. My question is because of the high deductible does it make more sense to just go out of network and pay out of pocket or probably pay more at the insurance co's DME?
Same questions about the masks and accessories?
What kind of help do you get with the online services? Ie: setup help, mask fitting?

I don't have my results yet but the Dr has told me that I will need a CPAP machine.
I am sure I will be back here often with more questions.
Thanks,

I am in the exact spot as you. Same deductible and I haven't paid a penny towards it yet. I ended up getting my machine secondhand from an approved retailer of this board and mask from our sponsor. I didn't need my machine set up but the company I ordered from, but said they would program the machine if needed. As for the mask, our sponsor offers free return insurance on some masks, or you can purchase it. This allows you to try it out for 30 days or a little less and send it back if you can't use it. I researched a LOT and seemed to have gotten the exact right nasal pillows so I didn't need to use the insurance but it was good to know I could send it back.

After buying the machine in my signature, a modem for data reading, the nasal pillows, a second FFM for congestion, a snuggle hose, and aromatherapy I spent around $550 out of pocket. I'm pleased with that and I own all my equipment so no overpriced rental fees. My insurance company wanted me to RENT the equipment for $678 for 3 months. No thank you.

Just make sure you get a data capable machine.

Sheriff

Thanks everybody
I think I have decided to go out of network and get a nice machine online for less then the discounted insurance rate from a DME.
Unless something serious happens I will not hit my deductible

Keep us posted.

Sheriff