Does this sound kosher? DME machine switch

I got my cpap on 7/17/07 and have since decided I want an apap (because of my bad back I need to sleep for an hour or two sitting up - and my 15# of pressure makes me wake up almost choking) - otherwise I love the machine and have been 100% compliant.

I got my doc to write me a new rx and they faxed it to the DME. They called me today to schedule a time to replace the machine. I asked if the insurance company (United Health Care) approved the change and they said that they were just doing it for me "out of the kindness of their hearts" since I had had the machine for only a short time. They said they were not going to change the bill even though the apap costs more.

My insurance had orignially told me that they are renting the machine until the end of the year and if it all works out will buy it then.

So, does this sound kosher?

Btw the cpap they originally brought out was brand new. And the RT was great.

Thanks everyone - you have been a lifesaver to this newbie!

It sounds normal to me.

Many insurance companies rent machines until the patient makes whatever they consider compliance. The rental goes towards the purchase of the machine so the cost should be the same whether you rent 3 or 6 months. Only difference is if you rent between two insurance years and may owe another deductable in addition to your copay.

If the DME is not changing the billing so that the out of pocket you signed up for is still the same, and they are not trying to charge you an extra charge for the APAP, I don't see any problem.

Goodness of their heart? I think not. Take it and don't look back if all the stuff I wrote at the top is true.

Take the DME's information about the switch to an auto w/a grain of salt. Both the straight CPAP and the autos are billed at the same HCPCS code and billable amount. On the other hand, a large majority of DME's "would" have given you a hard time or would have refused altogether so there was "some" goodness of their heart involved. It is true the auto costs THEM more than a straight CPAP. And some will only make the switch if YOU pay more.

We're delighted to hear that so far this DME has been working w/you and that you are happy w/them.

Thanks - they actually did tell me it was the same billing code but that the machine would cost them more. And, now they have a used machine - only 1 month but still used as opposed to new.

It was "the goodness of their hearts" that, unfortunately, put me on high alert. I tend to be mistrustful of the medical system and this extends to DME suppliers...

I appreciate the feedback.

I know EXACTLY what you mean about their "goodness of their heart" statement throwing up red alert signals immediately!!! They could have left that out and just mentioned that the auto did cost THEM more. That would have been fair. Either way, so far they seem to be doing good by you.

From all indications it appears that you have a good DME! I'm glad for you, especially after the shinanigan mine pulled on me in the first couple of weeks. ALl is well now, and I don't think they'll try it again. They know better now. But it'snice to have a good one from the start of things, as you seem to have.

The same thing recently happened with us. Got Ron's CPAP at the end of June, and decided he wanted to try an APAP less than a month later. It took just a phone call to get the doc to write the "OK", and the DME (which is also very good) got him switched to a new machine that same week. I basically told them what machine I expected, which was a no-brainer anyway since we already had the humidifier. They didn't charge any extra for the new machine, and the other terms per insurance remained the same.

This was a GREAT decision, and I'm glad to have done it so soon into treatment. The sleep center had him at a pressure of 18, and the APAP is now averaging around 10. Talk about a difference! He knew something wasn't right from the start. APAP was the best decision, and it was worth a little proactive self-diagnosis.

Now to find the perfect mask .....