trying to shop, compare prices

[mo.sleeper]

hello,
I've been using a cpap for almost 10 years. the resmed E8 is still working fine, but I want to get a backup unit. possibly a cpap with humidifier that has an easy to clean reservoir. I'm on medicare and use a St.Louis company, Essence for part C. going in network, I get directed to a medical supply company, who says I need a new sleep study and prescription to get signed up-- then they will discuss pricing.
what I want to know is which is cheaper, going thru the insurance, paying the copays for sleep study and machine, -or- getting my gp doc to write me a prescription and order a machine online(out of network).

thanks

[palerider]

hello,
I've been using a cpap for almost 10 years. the resmed E8 is still working fine, but I want to get a backup unit. possibly a cpap with humidifier that has an easy to clean reservoir. I'm on medicare and use a St.Louis company, Essence for part C. going in network, I get directed to a medical supply company, who says I need a new sleep study and prescription to get signed up-- then they will discuss pricing.
what I want to know is which is cheaper, going thru the insurance, paying the copays for sleep study and machine, -or- getting my gp doc to write me a prescription and order a machine online(out of network).

thanks

sending a PM to grayghost4 and asking what he can do for you will probably be the cheapest reliable method. cheapest may be local craigslist, but you have to know what you're looking for (ghost knows how to test and what's what in the cpaps).

next most expensive would probably be the gp and online at secondwindcpap.com,

next most would be other cpap retailers.... but you'd have to run the numbers.

[BlackSpinner]

The first thing is to call your insurance company and find out what the real deal is. Never trust a DME to give a real answer.

[chronic]

Blackspinner wins the prize for best answer.

[Janknitz]

Ditto the insurance. If you are on Part C Medicare, your co-payments MAY be covered by your plan, but the only way to know for sure is to ask (even better if they can give you something in writing). If you want your insurer to pay for it, you also have to figure in your out of pocket costs for co-payments and deductibles for the sleep study and face to face doctor visits, if any. They may be little or none on your part C plan, but that's what you need to know before going forward. Don't forget that deductibles reset January 1st, so timing may be an issue as the year is winding down.

Finally, with a Part C plan you may have little or NO choice as to machines, so you have to factor that in as well.

[LSAT]

Ditto the insurance. If you are on Part C Medicare, your co-payments MAY be covered by your plan, but the only way to know for sure is to ask (even better if they can give you something in writing). If you want your insurer to pay for it, you also have to figure in your out of pocket costs for co-payments and deductibles for the sleep study and face to face doctor visits, if any. They may be little or none on your part C plan, but that's what you need to know before going forward. Don't forget that deductibles reset January 1st, so timing may be an issue as the year is winding down.

Finally, with a Part C plan you may have little or NO choice as to machines, so you have to factor that in as well.

I have a Medicare Part C..Medicare Advantage Plan thru AARP. I had no problem selecting the machine I wanted.

[Janknitz]

Ditto the insurance. If you are on Part C Medicare, your co-payments MAY be covered by your plan, but the only way to know for sure is to ask (even better if they can give you something in writing). If you want your insurer to pay for it, you also have to figure in your out of pocket costs for co-payments and deductibles for the sleep study and face to face doctor visits, if any. They may be little or none on your part C plan, but that's what you need to know before going forward. Don't forget that deductibles reset January 1st, so timing may be an issue as the year is winding down.

Finally, with a Part C plan you may have little or NO choice as to machines, so you have to factor that in as well.

I have a Medicare Part C..Medicare Advantage Plan thru AARP. I had no problem selecting the machine I wanted.

It depends on the Advantage Plan. Kaiser is also an Advantage plan but it gives you NO option as to what machine whatsoever. That's why she needs to ask.

[mo.sleeper]

thanks for the replies.
when I got my machine 10 years ago, I was on my wifes insurance thru where she worked. at that time the resmed e8 elite, thru a local med. equip. supplier(setup and delivered to the house) was $2100. (I was about $200 out of pocket). also, at that time, I could have bought the same machine online for $795. I'm going to stop right here, before this turns into a rant.

[Janknitz]

They haven't really gone up much in price if you buy new directly online. Take a look at our host's CPAP.com site.

Retail prices quoted by brick and mortar stores are the owner's fantasy. Insurance pays what it decides to pay. You pay more than the direct online retail price on Medicare because service and maintenance is SUPPOSED to be part of what Medicare is paying for (ha!).

[SewTired]

My comments reflect Original Medicare. If you have an Advantage plan or go through an HMO or Kaiser, just skip this answer as some of it will not apply and just confuse you.

Medicare will accept a sleep study that is within 10 years. You need a copy of the original study, not just the summary. All you need to get then is your doctor's notes (face-to-face where you discuss your need for a cpap and replacement) and a prescription from your doc. Medicare pays 80%, you pay 20%.

I paid about $10/month for the rental for 13 months. Now it's my machine. I also had to pay the 20% up front for the humidifier (even though it was integrated) mask and initial supplies (I think about $45). If you get a Respironics unit, I highly recommend asking for the unit with the heated hose. You don't have to use a heated hose after that, but you can't go backwards. The heated hose comes with a different power brick and top.

I have a tier one supplemental plan and they pay nothing towards cpap. The tier 3 plan that my bro has pays everything that Medicare does not - he has had zero costs.

While it is less hassle to just get a prescription from your doc and buy online, my doc refused to get involved because he knows nothing about sleep medicine and cpap. I will let others discuss the used market, but my spare machine was bought used over Craigslist (I would have bought one from GreyGhost if I didn't come across this local deal). Other cpap, bipap and ASV users have only ever had used machines and they've saved a fortune. No matter what you get, you want a modern machine that works with Sleepyhead.

The advantage of going through a sleep study (which is between about $1,200 and $3,500 - you pay 20% if you have no supplemental) is that they may identify issues outside of apnea. Had I not discovered by accident a few months earlier that I had bradycardia, my heart problem would have been identified at the sleep study. That said, if you have never had a head injury and have no identified cardiac or respiratory issues, you can request a home study, which may be a lot cheaper.

[KardiacKeith]

I'll sell you a Resmed S9 VPAP ST at a remarkable price. It has 23 hours of use. It is basically brand new.

[BlackSpinner]

I'll sell you a Resmed S9 VPAP ST at a remarkable price. It has 23 hours of use. It is basically brand new.

This person has no history on this site. There is no guarantee it actually owns this machine.

[palerider]

I'll sell you a Resmed S9 VPAP ST at a remarkable price. It has 23 hours of use. It is basically brand new.

a specialized machine, for specialized needs. not good for the average person.

[KardiacKeith]

I'll sell you a Resmed S9 VPAP ST at a remarkable price. It has 23 hours of use. It is basically brand new.

This person has no history on this site. There is no guarantee it actually owns this machine.

I understand. I can post pictures. Give you my FB a and Twitter handles. I'm not trying to scam anyone. Anything to make the buyer feel secure. I just bought the Resmed Air Sense 10 as it fits my needs better. I'm sure I'll be posting more about the questions I have on the ins and outs of sleep apnea

[JimW159]

...the resmed E8 is still working fine, but I want to get a backup unit. possibly a cpap with humidifier that has an easy to clean reservoir...

Is your need for a straight CPAP (single pressure setting) or an APAP (high-low range automatically selected as needed)?
If CPAP, I have a RESMED S9 Elite with heated humidifier that I no longer use and have not used for over two years. It would include a tank, SD card, several filters, a hose (standard 22mm or thinline -your choice), and the carry bag. What it is missing is the power brick (I can't seem to find it but will continue looking - I may have left it behind on a trip). My offer would be to offer it to you for $25 + shipping and you would need to get a replacement power supply (often available for about $25-$35 on eBay). I will provide you with photos of the unit as well as full information regarding run hours, etc. if you are interested. You will not be buying a pig-in-a-poke.
On the other hand, if you need APAP, I also have a ResMed S9 Autoset with heated humidifier. It is what I got to replace the Elite mentioned above; it is configured essentially the same as the Elite but DOES have the power supply unit. The offer for this unit would be $90 + shipping. I would provide what pictures and information you may need prior to any transaction. I may have two heated hoses for the S9s, as well and would include one in addition to the normal hose with either machine for $15 more.
Everything will be thoroughly cleaned prior to shipping and will be shipped through USPS Priority Mail. I would ask that payment be through PayPal to provide security and offer you a level of protection in the transaction.
If interested, let me know either through this forum or private message.