Got my first cpap today - what a scam

I just got my cpap machine today. It's a REMSTAR SE 220P with humidifier. The guy who delivered it to me said it was worth $1000 and the mask $160. He said mask tubing and filter needs to be changed every 6 months so according to him it's around $1400/year total. Yet they are charging the insurance $180/month! At least I only pay $60/month because I've already hit my deductible this year. So anyway $1400/$180 is about 8 months to pay the entire cost of the device which is already very high. But then I google it and find this: http://www.directhomemedical.com/pr-sys ... UQwq3BHarU. The same machine at $339 and $69 for the mask. What a scam!

Is it possible to negotiate directly with your insurance to buy a machine and have them cover some of the cost?

A lot of us buy everything online, e.g. from Cpap.com, the sponsor of this site. You should ask your insce. co. if they're ok with being invoiced by them (most are, but...).

You might want to read this
https://maskarrayed.wordpress.com/
Especially the part lower on the page "help I am stuck with a brick" because that model 220 gathers no useful data at all.

And as to how insurance will handle things...that varies widely among insurance companies so you might start by reading this
https://maskarrayed.wordpress.com/what- ... me-part-i/
I would be checking to see if there are other choices for equipment suppliers in your area that work with your insurance company.

Hoses don't need to be changed very often...for years with common sense care and depending on the type of hose you can often find them online for less than insurance co pays.
Masks are expensive but often the hard plastic shell parts don't need replacing unless they break and the only part that might need replacing is the cushion (depends on the mask)
Filters can be bought in bulk online and often get 12 for what 2 will cost through the DME.

Your biggest priority right now...swapping the brick for a full data machine.

FranckDG wrote:I just got my cpap machine today. It's a REMSTAR SE 220P with humidifier. The guy who delivered it to me said it was worth $1000 and the mask $160. He said mask tubing and filter needs to be changed every 6 months so according to him it's around $1400/year total. Yet they are charging the insurance $180/month! At least I only pay $60/month because I've already hit my deductible this year. So anyway $1400/$180 is about 8 months to pay the entire cost of the device which is already very high. But then I google it and find this: http://www.directhomemedical.com/pr-sys ... UQwq3BHarU. The same machine at $339 and $69 for the mask. What a scam!

Is it possible to negotiate directly with your insurance to buy a machine and have them cover some of the cost?

It's only a "scam" if you're gullible enough to fall for it or don't do your homework beforehand.

My insurance provider reimbursed me for 80% of the cost of my initial equipment order from CPAP.COM. But, I checked with them first and then paid for it out-of-pocket and then submitted an invoice to them (they considered me to be in-network) and they paid me from that invoice. On the other hand, if they hadn't been willing to reimburse me, I was prepared to pay for all of it out-of-pocket rather than have to deal with a local DME.


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FranckDG wrote:I just got my cpap machine today. It's a REMSTAR SE 220P with humidifier. The guy who delivered it to me said it was worth $1000 and the mask $160. He said mask tubing and filter needs to be changed every 6 months so according to him it's around $1400/year total. Yet they are charging the insurance $180/month! At least I only pay $60/month because I've already hit my deductible this year. So anyway $1400/$180 is about 8 months to pay the entire cost of the device which is already very high. But then I google it and find this: http://www.directhomemedical.com/pr-sys ... UQwq3BHarU. The same machine at $339 and $69 for the mask. What a scam!

Is it possible to negotiate directly with your insurance to buy a machine and have them cover some of the cost?

Take it back and insist on a full data machine like an S9 auotoset or Airsense autoset. Be prepared to walk out without a machine. No sense paying $60 a month for a machine with no data, when you can buy outright a lightly used S9 autoset with full data for $200-400 on craigslist.

The sad part is that they also charged me $300 to get the machine delivered. I'm calling them tomorrow to get my money back and return this machine.

FranckDG wrote:The sad part is that they also charged me $300 to get the machine delivered. I'm calling them tomorrow to get my money back and return this machine.

They sound like a horrible place, just looking to cheat people. I would also call the insurance company as they are being cheated as well and may take more action if they are informed.

The prices are way too high, and that is the lowest possible machine. You would definitely be better off with a different company, or just buying on your own.

I have my first machine coming next week. It sounds basic. wonder if I'll end up buying on my own too.

BTW, how do I "get" my prescription if I want to buy on my own? Do I have to ask doc for it? Is it a piece of paper that I fac to places like CPAP.com when making purchases or is it just a number I am given or something?

Hopefullady wrote:I have my first machine coming next week. It sounds basic. wonder if I'll end up buying on my own too.

BTW, how do I "get" my prescription if I want to buy on my own? Do I have to ask doc for it? Is it a piece of paper that I fac to places like CPAP.com when making purchases or is it just a number I am given or something?

The RX is something your DR writes. They will send one to the "DME" and you should request a copy of it and legally have the right to it as it is part of your medical record. You should always get a copy of this as you may need it down the road for CPAP equipment and supplies if you choose to go elsewhere.

You can then provide a copy of it to another DME or CPAP vendor via whatever means they need, most often now days, as a scan via email. Some online DME's like CPAP.COM have a way for your to submit your RX via their website or via FAX.

You can even take a picture of it with your phone and then use that image as an attachment.

You should also get a copy of your Sleep Study, so you have it on file. This might make it easier to get a new machine down the road as well and it provides important info about how you tested. Data from that can be used to setup your machine when you get it. You also have a legal right to this as well.

If you are going to buy an auto-adjusting CPAP like the S9 Autoset from cpap.com, do you need a specific Rx from your doctor? I am pretty sure the Rx she had was for a regular cpap machine...

If buying online from some place like cpap.com you do NOT need anything other than a regular cpap machine RX.
The reason is....APAP machines are cpap machines but they just have another mode of operation that allows for auto adjusting (apap) pressures.

You only need a different RX should you wish to step up to the bilevel machine category and that's a different HCPCS code.

Plain CPAP or a CPAP with APAP mode...all are E0601 HCPCS code.

Pugsy wrote:If buying online from some place like cpap.com you do NOT need anything other than a regular cpap machine RX.
The reason is....APAP machines are cpap machines but they just have another mode of operation that allows for auto adjusting (apap) pressures.

You only need a different RX should you wish to step up to the bilevel machine category and that's a different HCPCS code.

Plain CPAP or a CPAP with APAP mode...all are E0601 HCPCS code.

Great, thanks!

Great info, thanks. I hadn't thought of taking a photo w/my phone to send it to a supplier.

Pugsy, If I want a machine that has the exhale relief, would a regular script be that same HCPCS code?

I know I will learn as I go along. I am trying to prepare myself as I talk to DME company and see what kind of leverage I might have...!

Your leverage is your money. Tell them you are interested in your health and want a machine that will perform well as well as provide data that shows the details of what is going on. If they are willing to work with you, fine tell them you want xxx machine. If they don't want to work with you, fine take your money elsewhere.

The key to all of this is is to read and educate yourself FIRST before you make any contact with the DME.
If you go in well educated you will probably know more than the person you deal with at the DME. You may intimidate them but that is better than them intimidating you. When you know exactly what you want and insist on getting it and nothing else. And you know what it should cost, you know weather to accept their offer or walk out. There is nothing like showing a salesman your backside to get his attention.