DME & rental/purchase confusion

I started CPAP last week, so far everything is going pretty good.

My insurance (Cigna) requires use of Carecentrix to get my CPAP and related supplies, which seems is handled by American Home Patient, at least in my area. Not knowing anything about CPAP and the whole process, I picked up my CPAP last week, got fitted for a mask, and didn't pay too much attention to the invoice as it will be sent to my insurance (or carecentrix, I'm not quite sure of the process.)

There is a reasonable fee for the rental, though I can't seem to find how long that is. There are unreasonable charges for the mask, headgear, hose, etc ... which I'll just have to suck up. Next time I'll have my doctor call in a prescription to cpap.com for supplies.

But the thing that's odd is a $350+ charge for a heated humidifier. I have the Resmd airsense 10, which has the humidifier built in. Why would there be a charge for the humidifier? If I don't keep the unit after the rental period (again, no idea how long), do they want me to saw the right half of the device off since I paid for it? Something doesn't seem right.

What happens at the end of the rental? Do I have an option to buy? Will it likely be outrageous through them and be better off buying from cpap.com? I have a high deductible plan, and haven't met my deductible (I never do), so I pay for everything out of pocket.

You may compare prices, and make up your own mind after doing the math.
If you have been issued the Airsense 10 "CPAP" (the brick", you can and will do better
where you can get the Autoset or Autoset for Her.

Chilehead wrote:I started CPAP last week, so far everything is going pretty good.

My insurance (Cigna) requires use of Carecentrix to get my CPAP and related supplies, which seems is handled by American Home Patient, at least in my area. Not knowing anything about CPAP and the whole process, I picked up my CPAP last week, got fitted for a mask, and didn't pay too much attention to the invoice as it will be sent to my insurance (or carecentrix, I'm not quite sure of the process.)

There is a reasonable fee for the rental, though I can't seem to find how long that is. There are unreasonable charges for the mask, headgear, hose, etc ... which I'll just have to suck up. Next time I'll have my doctor call in a prescription to cpap.com for supplies.

But the thing that's odd is a $350+ charge for a heated humidifier. I have the Resmd airsense 10, which has the humidifier built in. Why would there be a charge for the humidifier? If I don't keep the unit after the rental period (again, no idea how long), do they want me to saw the right half of the device off since I paid for it? Something doesn't seem right.

What happens at the end of the rental? Do I have an option to buy? Will it likely be outrageous through them and be better off buying from cpap.com? I have a high deductible plan, and haven't met my deductible (I never do), so I pay for everything out of pocket.

You will need to call your insurance company as there are different methods of doing this. Some insurance companies pay for 2-3 months of rental, and if you satisfy compliance, then they convert it to a purchase. This is how my insurance did it. After 2 months, the machine became mine. Many others have a rent to own, usually 13 months, and then the machine is theirs. I believe a few have a perpetual rental, and it would be cheaper to simply buy your own.

Humidifiers are usually billed separate as a purchase rather than a rental. There are a lot of billing things that don't make sense. For example, a mask and headgear that come in the same sealed bag but billed separately.

zoocrewphoto wrote: For example, a mask and headgear that come in the same sealed bag but billed separately.

Yes, that was the other odd example. I assume, but don't know yet, that the amount billed to the insurance will be more than what insurance will allow, and they will reduce it to an agreed upon value in whatever contract they have. At least I see this with most doctor visits.

You can CALL your insurance to determine the allowable;
but I urge you to make sure you have the FULL DATA model.
Anything less is just a shot in the dark. (Or many shots)

1. Even though the humidifier is integral to the new ResMed machines, DME's Bill separately for it as a purchase. I don't know why or how they are able to do this, but most insurers, including Medicare, allow it. Same with mask and headgear, as you've already noted.

2. Pay no attention to the list prices on your bill. They are pure fantasy on the part of your DME. Your insurer has negotiated prices for each item, your out of pocket expenses will be your co-pay or deductible based on what your insurer sets as the price, NOT what the DME fantasizes you will pay. NEVER pay the billed amount until your insurer has determined your share. Never trust or rely on the DME to tell you what you will owe. Only your insurer can determine that. Be aware of deductibles, but you still get the insurer's price when meeting your deductible.

3. See my blogpost called "Don't Pay That Upcharge". Don't get suckered in to paying extra for items covered by your insurer.

The normal way that cigna does things is the 13-month rent-to-own process. My insurance company uses the cigna network, but the coverage is not cigna's coverage. My insurance has a 2-month rental and then wants to be billed for the balance. So of course this caused an insurance/DME fustercluck...

I got the machine on Oct 10th, and the DME billed for 1 month rental on Oct 10th, with separate line items for the unit and the humidifier. And billed for the mask and hose, which was not the heated hose, which was on back order. Insurance adjusted the amount and then paid 80%, DME billed me for 20%, which I paid. Ok, then Nov 10th, DME billed for another month's rent on machine and humidifier, and the heated hose, which came in. Insurance adjusted the amount and then paid 80%, DME billed me for 20%, which I paid. Then came Dec 10th, when the DME was supposed to bill for the balance owed on the machine. They instead billed for another month's rent, as well as a new mask. The insurance paid for 80% of the mask and rejected the machine & humidifier with a comment saying to bill for the balance. I paid my 20% for the mask, and then came January. Where the DME -- which obviously doesn't read the reason codes when insurance rejects stuff, shoved through the rental again. This time (inexplicably) the insurance paid the third month rental (or 80% after they took their discount, anyway) and I paid my 20%. Then followed the next 4 months where the DME kept submitting rental charges and the insurance company kept rejecting them asking for the purchase price. Then they submitted the net prices (purchase minus the 3 months rentals) but they evidently used the code for a rental again, and so that got rejected. Finally after another 2 months, they resubmitted the net prices, apparently coded as a purchase, but then the insurance company subtracted the 3 months of payments that they had made, so that got subtracted twice. The net result is that my insurance paid $714.96 and I paid $178.74 for a total of $893.70, while CPAP.com charges $883 for the same machine. So after a long convoluted process, the DME ended up only getting paid $10.70 more than cpap.com would have charged.

A rational outcome, alas incredibly unusual in this modern day and age of insurance companies and computerized billing!

The problem if the DME can't figure out whether to bill for rental or purchase after the required time period is that it's October now, and you may end up with a bill for the balance after January 1, when your new annual deductible kicks in. You could end up paying more out of pocket because they screw up. So around this time of year you have to be careful. If it's a 3 month rental then purchase, get on their case to make sure the remaining purchase bill gets out before December 31, or you may be stuck.