DME/online/insurance question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
widmark
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DME/online/insurance question

Post by widmark » Tue Oct 21, 2014 11:12 pm

Hello, first post. Sorry if this has been covered, I did a cursory search and didn't see anything.

I've been using my CPAP for 2 years or so now and have had consistent issues with my DME, which is the company that was used by my sleep doctor. I finally got fed up and decided to try to get my supplies online. That DME is still who I'd have to deal with if my CPAP broke, but I'd rather not have to deal with them to just get a new mask and headgear, tubing, filters etc. I figured I'd order online and my dr. gave me a prescription for the mask. What I didn't realize until I tried ordering was that most of the online sources will sell you at full cost requiring you to then get reimbursed from your insurance. With the DME, I just placed my order, they cleared it with my insurance and then billed me for just my portion (a co-insurance which is much cheaper).

My question is, are there any sources to purchase masks from online that would go through my insurance first as the DME does?

Also, are there any DME's in the NYC area people have had good experiences with?

Thanks in advance.

Guest

Re: DME/online/insurance question

Post by Guest » Wed Oct 22, 2014 1:20 am

widmark wrote:Hello, first post. Sorry if this has been covered, I did a cursory search and didn't see anything.

I've been using my CPAP for 2 years or so now and have had consistent issues with my DME, which is the company that was used by my sleep doctor. I finally got fed up and decided to try to get my supplies online. That DME is still who I'd have to deal with if my CPAP broke, but I'd rather not have to deal with them to just get a new mask and headgear, tubing, filters etc. I figured I'd order online and my dr. gave me a prescription for the mask. What I didn't realize until I tried ordering was that most of the online sources will sell you at full cost requiring you to then get reimbursed from your insurance. With the DME, I just placed my order, they cleared it with my insurance and then billed me for just my portion (a co-insurance which is much cheaper).

My question is, are there any sources to purchase masks from online that would go through my insurance first as the DME does?

Also, are there any DME's in the NYC area people have had good experiences with?

Thanks in advance.
Unfortunately I don't know any online DME who will accept your insurance but you might get more replies if you mention just who you do have insurance with as they are all different, regional, and even the same co. will have different policies. So now we know NYC but no insurance mentioned.

Then of course it depends on just how much your co-pay is and your annual deductible; sometimes it is still cheaper to buy out-of-pocket (OOP).

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Re: DME/online/insurance question

Post by JDS74 » Wed Oct 22, 2014 3:52 am

After two years, you don't have warranty coverage anymore for most machines.
So you can get repairs at other places. I used:

Accurate Biomed Services
(800) 376-5660
100 North 17th Street
Bethany‎ MO‎ 64424
United States of America

Check with your insurance company about reimbursement for direct purchases of CPAP supplies.
If they allow that, then any online vendor who will provide you with an invoice that includes a cpt code, their address, etc., and their taxpayer ID will be suitable.

I get my masks that way as well as my current machine.

BTW you should get a backup machine or you will be tied to your original DME for repairs since they can give you loaner equipment.

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Re: DME/online/insurance question

Post by Guest » Wed Oct 22, 2014 6:46 am

I do believe that any licensed DME can handle the warranty repair of any machine whether they sold it to you or not. It really is just a matter of mailing it into the mfg., nothing more.

Just as any car dealer can handle the warranty repair of a car you did not buy from them; they just have to sell that brand of car.

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chunkyfrog
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Re: DME/online/insurance question

Post by chunkyfrog » Wed Oct 22, 2014 6:52 am

But, they could refuse anyway. I don't think Medicare likes that, but if they want your business, YMMV.

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Pugsy
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Re: DME/online/insurance question

Post by Pugsy » Wed Oct 22, 2014 7:12 am

There are cpap suppliers online that will file insurance in lieu of payment...that's where they file your insurance and you only pay your copay and insurance pays them what they normally pay....or if you have another secondary insurance (like a Medicare supplement) then you don't have any out of pocket expenses.

You would need to check with your insurance to make sure that they will work with the online cpap supplier as in be "in network" so you get best price.
There's several that say they will work with insurance.
Liberty Medical is on that comes to mind because they advertise on TV all the time.
Easybreathe.com is another http://www.easybreathe.com/Carriers-53. ... MgodpX8ApA

There are some others but those are the only ones that come to mind right now.
This one I think does mail order and also has brick and mortar stores
http://www.ahom.com/services-and-products/sleep-apnea

Always do your homework and verify that your insurance is okay with who you choose.

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widmark
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Re: DME/online/insurance question

Post by widmark » Wed Oct 22, 2014 7:16 am

Pugsy wrote: You would need to check with your insurance to make sure that they will work with the online cpap supplier as in be "in network" so you get best price.
There's several that say they will work with insurance.
Liberty Medical is on that comes to mind because they advertise on TV all the time.
Easybreathe.com is another http://www.easybreathe.com/Carriers-53. ... MgodpX8ApA
easybreathe was one that wouldn't work. Maybe it's my specific insurance, Anthem Blue Cross Blue Shield network, but that's not the feedback I got from them. I was simply told I had to pay and my insurance would reimburse me.

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Pugsy
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Re: DME/online/insurance question

Post by Pugsy » Wed Oct 22, 2014 7:23 am

I know nothing more than what is advertised...and we all know what advertising means. The EasyBreathe I saw the other day and just happened to jot it down. I didn't go into any particulars with any online supplier. I have a local guy I use.
You might check Liberty Medical...or American Home Patient.

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cathyf
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Re: DME/online/insurance question

Post by cathyf » Wed Oct 22, 2014 7:36 am

Last month I had an enlightening conversation with a cigna customer support lady, who sent me her lists of IL and IA cigna network providers. She recommended

Edgepark Medical Supplies
(800) 321-0591
Participates in: LocalPlus, HMO, OAP, OAPC, PPO

She warned me off of Carecentrix (other people on this board have Carecentrix horror stories, too.) Carecentrix is the reason that Lincare refuses to take CIGNA patients -- their business model is apparently to screw things up so badly that people give up and die rather than deal with them.

widmark
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Re: DME/online/insurance question

Post by widmark » Wed Oct 22, 2014 11:17 pm

Pugsy wrote: This one I think does mail order and also has brick and mortar stores
http://www.ahom.com/services-and-products/sleep-apnea
I haven't contacted them yet, will call tomorrow, but the site looks great, sounds like they take care of the insurance stuff first, which is what I'm looking for. Will report back.

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archangle
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Re: DME/online/insurance question

Post by archangle » Thu Oct 23, 2014 9:34 am

There have been quite a few people who have reported that their insurance will only pay for supplies through a local brick and mortar DME. Even though many of them are just fronts for national DME's that ship all the supplies via mail order anyway.

Gotta love the medical mafia.

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Re: DME/online/insurance question

Post by widmark » Sat Oct 17, 2015 4:01 pm

Now it's a year later and what an adventure it's been. I got a new job with better healthcare, now on United Healthcare, but still struggling to find a DME. They listed a few that had nice websites, but terrible reviews online like Apria.

My takeaway is there are great companies with easy to use websites online who are almost always out of network, and then there are the companies that don't compete for customers because they exist on Dr. referrals and customers who don't know to shop around.

So I'm still looking for a good DME, location anywhere, that is in network for United Healthcare. Edgepark was mentioned above and they are in network, but yelp reviews are not promising. I don't always rely on that, but it's a start.

Anybody with a specific United Healtchare network DME to recommend?

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chunkyfrog
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Re: DME/online/insurance question

Post by chunkyfrog » Sat Oct 17, 2015 4:17 pm

UHC was one of the worst health insurance companies I have ever been afflicted with.
I hope your experience is better than mine was.
At this point, call the company and get a hard copy of all their in-network providers; (local and away)
then do the math. You just figure out what your supplies would cost with or without their "help".
[Ask what their contracted payment is for what you expect to need, especially if they will cover a newer machine.]

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Re: DME/online/insurance question

Post by widmark » Sat Oct 17, 2015 4:32 pm

I will do that, but this isn't a question about in network vs out of network. I've done the math and I've done out of network and it's a lot more expensive. I'm just hoping to find an in network DME that isn't incompetent. There's 130 responses on their website and that's just within 20 miles of me. There's no way to search nationwide. I'm starting to research those providers but figured if anybody had a recommendation, that would be a useful shortcut.

Sorry you haven't had good experience with UHC. I'm not having a great experience, but it's better than anything I've had in the past.

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Re: DME/online/insurance question

Post by Wulfman... » Sat Oct 17, 2015 4:33 pm

widmark wrote:Now it's a year later and what an adventure it's been. I got a new job with better healthcare, now on United Healthcare, but still struggling to find a DME. They listed a few that had nice websites, but terrible reviews online like Apria.

My takeaway is there are great companies with easy to use websites online who are almost always out of network, and then there are the companies that don't compete for customers because they exist on Dr. referrals and customers who don't know to shop around.

So I'm still looking for a good DME, location anywhere, that is in network for United Healthcare. Edgepark was mentioned above and they are in network, but yelp reviews are not promising. I don't always rely on that, but it's a start.

Anybody with a specific United Healtchare network DME to recommend?
What's your situation with deductibles and co-pays? Do the math if they're a factor.
For those reasons, I never used a brick and mortar DME.......bought everything from online or private sellers. Have never regretted it, stocked up on equipment and supplies that will probably last me forever. And even now that I'm on Medicare I won't use them, either. Don't need to.


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