Insurance switch during CPAP "rent to own"

Hi all,

I'm new here as a member, but found some good advice here about masks and such before getting my CPAP this past July. Thanks!

Unfortunately, my work recently switched our healthcare insurance from an HMO (Blue Shield) to a high-deductible PPO (Cigna). This is quickly becoming a headache with my CPAP...

My APAP machine (REMStar 60 + Humidifier) is supplied by LifeCare Solutions and was on a 10-month "rent-to-own" deal, of which 6 have elapsed. I paid the initial copay, along with the smaller monthly copays that have been billed since. In total, I believe I've paid around $250 in copays. Dealing with LifeCare was awful, but I only had to deal with them for a couple of weeks at the beginning. Compliance was easy, a few months in I brought it to my physician to check the logs.

As mentioned, I've now been switched to a high-deductible PPO via Cigna. Since the deductible is much greater than a CPAP machine, I figured my best bet would be to contact LifeCare and ask if I could just pay off 100% of my balance that they would have billed Blue Shield. Not only is that not allowed, but since I am switching insurance plans, the "rent-to-own" resets to zero(!!), and is now a 15-month "rent-to-own" program! (I am 100% NOT going to do a 15-month, as I'm considering switching to my wife's insurance for 2016 and don't want to go through this again.) I asked what the cost would be if I could buy it outright, and they directed me to the insurance company for that info.

So I contacted Cigna, and they put me in touch with their "sleep management" department, which is actually managed by a 3rd party company, CareCentrix. They informed me that it is actually a 6-month "rent-to-own" deal! (I still need to resolve that discrepancy with LifeCare.) There's also no option to just buy outright, you have to go through all six months. I'm also evaluated for compliance each of the first 3 months (though I don't know how...).

What I would love to do is return the machine to LifeCare Solutions, and buy one directly from cpap.com. Just bypass all the nonsense. But I'm not sure if this is possible, and even if it is I'm worried that (1) LifeCare would still bill the first month to Cigna (where I'd owe $370), (2) that Cigna might not apply a cpap.com machine towards my deductible (as punishment for not going through their official process), and (3) that Cigna might not allow me to apply my HSA monies towards the cpap.com machine. Basically, I'm worried that I might be paying significantly more if I go this route (and that it might be a nightmare to deal with!).

I'm wondering if anyone else here has been in a similar situation, and if so, how it worked out and if you have any advice. Thanks!!

If they received money for the machine as a rental, they can't make it start all over. They have to credit you that amount.

Mine was the same, 10 month to own, paid 4 months and then new insurance. the DME credited me for the 4 months and the balance is being paid off (after my 850 deductable) as an 80% insurance 20% co-insurance (me)..

This was an ok option for me since if I bought elsewhere I still had the 850.00 deductible regardless and may not be able to use my FSA for any of it.

Since the deductible starts over, and your deductible is high, you may need to
send the existing machine back (do NOT sign a refusal of therapy statement!) and change suppliers
This forum is sponsored by cpap.com, whose prices are very reasonable.
Secondwindcpap.com sells gently used and open box machines at good prices too.
Both will accept a photocopy of your current valid Rx.

This is a pain, and you have to watch the DME because they are very happy to start the rental clock all over again on the very same machine.

If you have a big deductible on the new insurance, my advice is to turn in the machine you have and BUY your own replacement. Get the same make and model so you don't have to buy the humidifier again (typically, only the blower unit is a rental, the humidifier portion is purchased--but check and be sure!). Your out of pocket expenses will be far less, especially if you shop somewhere like Secondwind.com. The only problem is your purchase may not count against your high new deductible.

I have Cigna also with high deductible. I have the same machine you do and without hitting my deductible I have to pay the full price of the rent to own for 6 months which costs me $123.66 a month.

Thanks everyone! I appreciate the responses and this definitely gives me some good things to look into & consider, particularly the credit with the DME & to see if I own the humidifier.

Oh, and if, by some chance you do meet your deductible fairly early in the year, then get insurance to pay for another blower so you have a backup.

Janknitz wrote:...
Get the same make and model so you don't have to buy the humidifier again (typically, only the blower unit is a rental, the humidifier portion is purchased--but check and be sure!). ...

I am battling the same scenario. I asked the DME explicitly what the retail price of the unit was and they gave me their number which was actually a little higher than retail but not so bad. But when it came to buying out the balance to be done with them they were not including the upfront one-time payments for humidifier, heated hose and filler tank - none of these items are billed monthly. All they were counting as paid toward the balance of the contract was the payments on code E0601 "Continuous airway pressure device". So they are off by $200 in their favor, and if I tell them to stuff it and return this thing I know they will try and ding me for the humidifier. Do I have a leg to stand on here?

You paid for the Humidifier, mask, hoses etc... you have a receipt or should have one. Even if your insurance has changed, you should still be able to access the claim information which shows you own it.

If you are returning the macine, you keep the items that were paid in full like the humidifier, hoses, masks etc... since those are not rented but paid for up front when you get the machine.

Krelvin wrote:You paid for the Humidifier, mask, hoses etc... you have a receipt or should have one. Even if your insurance has changed, you should still be able to access the claim information which shows you own it.

If you are returning the macine, you keep the items that were paid in full like the humidifier, hoses, masks etc... since those are not rented but paid for up front when you get the machine.

Reassuring, thanks. I am awaiting a call back of some kind from the level of bureaucracy. We'll see how this all works out, but I think the communication will have to revert to written only when that call is done if you know what I mean.

There is another thread on this page offering a new series 60 machine for $400.
If I were in your shoes I would buy it now and argue with the DME and insurance later. Worst case is you wind up with a backup machine. Best case you negotiate from strength and give back your old machine and stop worrying about the DME and the deductable.