I need some help

firemarshal · Post by **firemarshal** » Fri Jan 21, 2005 2:36 am

I have had sleep study and waiting to hear back from Dr. and just trying to figure this out a head of time. I stopped by my local DME (small town only one) and they said that most insurance companies have you rent to make sure cpap is what you need. When I asked how much to rent they said $275 a month, holy crap. I then asked ballpark price on machines and they said somewhere between $1200 and $2500, again holy crap. I then asked why the price difference between DME and internet. The answer I got was that most insurance companies will not pay for cpap purchased over the internet, and that if I had problems that they would be "on call" to help with any problems. In two monthes of renting I would just be slightly over deductible. Called insurance company and they said that after deductible was met that I would have to pay 20% of the price of machince, again holy crap. Now what I need to know is, are they, the DME, feeding me a line? And if so what do all the experienced people out there suggest. I do not want to pay out the nose and just end up possibly puchasing one on the net anyway.

vernao · Post by **vernao** » Fri Jan 21, 2005 3:45 am

My experience was it is considered a lease purchase. When the amount paid by you and the insurance company reaches the cost of the machine, it is then yours. It is like buying the machine on installment plan. During the lease the RT company will service it etc, then when it is purchased you have to pay for the service.

chrisp · Post by **chrisp** » Fri Jan 21, 2005 10:36 am

Top of the line internet price for PB420E autotitrating cpap and humidifier with software and mask around $900. Plain cpap with all but software $599. Wave the $$$$ you saved on the internet at the DME when you drive by.. .IMHO https://www.cpap.com Free phone service also

As far as servicing ..Change the filter. Its right on the back . no tools. Not like it needs a oil change or something. If it breaks DME cant fix . Must go to manufacturer depending on unit. For the price of a rental you can buy a PB 420 s as a spare. LOL
Cheers,

Chris

FF/EMT/PSEL/I

wading thru the muck! · Post by **wading thru the muck!** » Fri Jan 21, 2005 11:04 am

Hi firemarshall

Yes the DME is feeding you a line. Ask them what hours they will be "on call." cpap.com answers their phone 8am till 10pm CST and you won't get the can'ts and won'ts that you'll get from the DME. What you will get is great prices and great service.

If I do the math in your case the $500 deductable plus 20% of the $2000 balance = $900 out of pocket. I'm sure that $2500 would not include the software. Most DMEs say they can't (there's that word again) sell it to you. Call your insurance and ask if you buy online can you submit for reimbursement yourself. If they balk tell them the online cost is less than half of what the local supplier wants to charge. This is what I did and it all worked fine.

For your $900 you can buy online and get the equipment you choose and not what the DME tells you. Browse the forum you will see many stories of DMEs saying can't get that kind or your Doc won't let us sell you that one. It can be frustrating.

The only reason to rent is to try out a particular machine. Two months rent = the cost of the best machine.

Any more questions feel free to ask. I know it might seem to good to be true, but in this case you will find it is. Although it may just be that the local DME experience is just to bad to believe.

firemarshal · Post by **firemarshal** » Fri Jan 21, 2005 3:44 pm

Thanks you wading, I am going to call insurance co. on Monday and see what they say. My wife said that we will not buy anything from the DME, bad experince with nebulizer for child, unless we absolutly have to, she feels the same way why spend money for nothing. I started adding it up and I will spend twice as much just to reach my deductible vs. buying the machine outright on the net. I am so glad to have found this site to get information from others who had to go through all the hassles and help us newbies out.

loonlvr · Post by **loonlvr** » Fri Jan 21, 2005 4:39 pm

I called my insurance company(Blue Cross) and they sent me a re-embursment form. I pay for it then get money back, less deductible. I just got a Remstar Auto C-flex with humidifier, Ultra mirage full face, and encore software for $1167.99. What a deal. Local dme wanted $2200 just for machine. It comes Thursday, then will submit form. Can hardly wait.

HOTTUBKID · Post by **HOTTUBKID** » Sat Jan 22, 2005 9:26 pm

My provider wanted 2500.oo for what I bought on the net for 564.00. My insurance paid 80% either way. Take your best guess. For what the provider wanted I could buy about five machines on the net,

Janelle · Post by **Janelle** » Sat Jan 22, 2005 9:35 pm

One thing to remember with insurance whether dealing through your DME or online is they will pay the percentage etc. for "reasonable, allowable and customary expenses". This may be quite a bit less than what the DME is charging you. But they have to take it. And you are only liable for what is left of the "quoted" amount, not the amount the DME charged. When DMEs are contracted to certain insurance companies, they have an agreement that the patient is not liable for any amounts above what the insurance company decrees is reasonable and customary.

If you have already started rental of a machine from a DME, the insurance will deduct that if you decide to order the machine online instead, from what they will reimburse you.