Help estimating costs

[Radio]

I did start a newbie thread but this was more of a general question so I think a new post is might be best.

I'm new to cpap, the recommendation from the study was for fixed cpap at a pressure setting of 10. After reading here I requested my doctor to write the prescription for auto cpap. The only nearby provider covered by insurance will be Lincare. It will be after the new year before I can get insurance approval and discuss costs with Lincare. I am trying to estimate the cost of just paying everything out of pocket using internet providers.

Can someone speculate on the first year costs? I am assuming $900 for Resmed 10 auto set. The difficult part is the masks and replacement parts. I think I want a nasal mask, but again no real experience here. My guess is I end up with 2 masks as I try to fine whats best for me.

Would $1400 seem like a good estimate for machine,two masks, and one year of replacement hoses, mask parts or other items? I know I can save a bit with a used machine but it is all the other bits and pieces that I really don't know about.

So if starting from scratch what would you recommend for startup? What would you estimate for first year cost.

[palerider]

and one year of replacement hoses, mask parts or other items?

One non heated hose: 8$

One heated hose: $35-$50

You shouldn't *need* any mask parts, unless you're overzealous in scrubbing them clean.

$0.80 for filters (assuming Resmed), unless it's dusty in your bedroom, in which case you might need to replace it more than every six months.

Ignore the "replacement schedule" that the DME will push on you, there's no legitimate reason to replace things until they stop working well.... the schedule is there just to make them more money.

[purple22]

Unless the landscape has changed. Internet providers will not accept insurance. An internet seller is pay for it all up front. The usual plan for insurance is for rent to own. Pay so much for a co-pay each month. I think, for Social Security, 13 months and it is yours. Insurance often uses a negotiated price structure for medical costs. Which does not mean so much, as the prices from some Internet sellers are excellent. Still a co pay over thirteen months is much more affordable to some. To use insurance also might mean another visit or two to the sleep doc to evaluate how you are doing, did.

[realshelby]

The sponsor of this forum has ResMed 10 Autosets for about $640. New with full warranty. You can buy a P10 nasal mask for about $75. Your hose should last all year. You might need a couple replacement pillows at $20 each or so. Up and running for under $725.

[palerider]

The sponsor of this forum has ResMed 10 Autosets for about $640. New with full warranty. You can buy a P10 nasal mask for about $75. Your hose should last all year. You might need a couple replacement pillows at $20 each or so. Up and running for under $725.

If you want to help https://www.cpap.com, then mention them in the post, so that google will pick it up, and rank their page higher on searches.

We don't have to play the silly apneaboard games here.

[DreamDiver]

I'm curious: Doesn't a DME like LinCare or Apria have to give you a contract delineating exactly what you have to pay out of pocket for the duration of your rent-to-own contract? Can you ask to see the exact particulars before signing anything? That would make the most sense to me. That way you can actually compare with buying outright.

[zoocrewphoto]

Unless the landscape has changed. Internet providers will not accept insurance. An internet seller is pay for it all up front. The usual plan for insurance is for rent to own. Pay so much for a co-pay each month. I think, for Social Security, 13 months and it is yours. Insurance often uses a negotiated price structure for medical costs. Which does not mean so much, as the prices from some Internet sellers are excellent. Still a co pay over thirteen months is much more affordable to some. To use insurance also might mean another visit or two to the sleep doc to evaluate how you are doing, did.

If there is a deductible involved (especially with very little else expected during the year), then this purchase, even with insurance, would be 100% paid by the person. No sense in paying DME mark up prices (even the insurance negotiated prices) if you are stuck paying it all anyway.

For masks, all you really need is to replace the cushion or hoses. How often depends on you. I use a full face mask and do about 2 cushions a year. I think pillows don't last as long, but it depends on you. I do try to get backups of stuff. Filters? Maybe a few a year. A hose lasts me a few years.

Overall, not much for ongoing supplies.

[ChicagoGranny]

It will be after the new year before I can get insurance approval and discuss costs with Lincare.

You would be asking the wrong people. You need to ask your insurance company. Your insurance company can tell you which DMEs they have contracts with and what the prices are. Insurance companies speak HCPCS codes. Most of the ones you will need when you talk to the insurance company are listed below. Good luck.


E0601 Continuous airway pressure (CPAP/APAP) device

E0562 Humidifier, heated, used with positive airway pressure (CPAP/BiPAP/APAP) device

A7030 Full Face Mask used with Positive Airway Pressure (CPAP/BiPAP/APAP) Device

A7034 Nasal interface (mask or cannula type) used with positive airway pressure (CPAP/BiPAP/APAP) device , with or without headstrap

A7044 Oral interface used with positive airway pressure (CPAP/BiPAP/APAP) device

A7027 Combination oral/nasal mask, used with continuous positive airway pressure device

A4604 Heated Tubing used with positive airway pressure device

A7038 Filter, disposable, used with positive airway pressure device

[purple22]

If the OP was using Medicare. Then often a DME is required to use a negotiated price for a piece of equipment. If ones income is low enough. Then the DME can choose to write off the Co-Pays. I would be a bit iffy on the DME writing off Medicare deductible, which I just read is like $4xx.00. Likely my medicare deductible will be written off by another medical provider, so the DME will not see it. A number of DME's advertise they write off the Co-Pays. I would guess some insurers have at least a negotiated price. None of this is fun to worry about.

I would say that I have bought from our forum providers. cpap.com, I have found them to be knowledgeable, friendly helpful. If you do order from cpap.com, do not just point and click off their website. Call them on the phone, they often have some kind of sale or deal they will make available to you. Like your best friend works for cpap.com

[ChicagoGranny]

I would guess some insurers have at least a negotiated price.

Purple, all insurance companies have negotiated prices for the items their policies cover.

[purple22]

I would rather not make statements of "all" unless I had done a good bit of research to be sure it is really true. In addition, it would be true if the savings was not minimal. And I am not sure how I would define minimal savings should translate.

Anyway, one of the posters suggested that the price from an online DME would always be less than buying through one's insurance. Insurance where one would only need to meet the price of a deductible, and then (probably) 13 co-payments. I would not want to make a purchase right after January first because that, for me, would be the maximum deductible. Whereas if I go to the regular doc, and he does standard blood tests, where the clinic system writes off the deductible. The DME might be less inclined to write off my yearly deductible. Which does not make it more likely that I will pay the four hundred something dollar deductible which the 'not in the real world' Congress has allowed for a beginning of the year deductible for Medicare.

I did want to leave the OP with one thought about dealing with a DME. The person who answers the phone at a DME is only meant to answer the phone, and likely can not tell you very much. The workers in the local DME office will say, until I can get all you personal information, and see about signing you up, then I can not do much for you but give advice. The machine you get depends on what your doctor wrote on the prescription, what you will be expected to pay depends on your insurance. In any case, those in my local DME office only try to help me with my therapy, the logistics of getting supplies. Anything to do with money is handled by an office in Florida. I would bet, that if you did not have insurance, they still could find a way to get a better price for a machine than the list the manufacturer has them say it is to be. Just the company is not going to say so known easily. I would guess they have an insurer who only contributes a price negotiation. Exactly what my local pharmacy does on some drugs. I am not sure the DME would do that.

Just I have seen those come on the forum breathing fire because the first person on the phone from the DME can not give them detailed information on what the customer has to pay when. Guys, they only answer the phone. They are not insurance experts or RT's or mind readers (know all about what your individual case needs.) Most of the second line of people only want to help me with my treatment. They do not know or care about the money part. They just try to help me use my machine.

[realshelby]

Just I have seen those come on the forum breathing fire because the first person on the phone from the DME can not give them detailed information on what the customer has to pay when. Guys, they only answer the phone. They are not insurance experts or RT's or mind readers (know all about what your individual case needs.) Most of the second line of people only want to help me with my treatment. They do not know or care about the money part. They just try to help me use my machine.

You have a different view of a DME than most here will offer. Which is good, if it means you think they are taking care of you! But saying they only answer the phone is troubling to me. These are businesses in business to sell/provide a customer with products and services. They actually better know all about your needs, as they better have a prescription to work from. That is all they need to know up front. Where they can actually "help" would be the service part of their business. Fitting of masks, helping set up equipment, and helping customers get the most out of what their insurance will provide! They had BETTER be insurance experts because the majority of their income is provided by payments from insurance companies! Part of being in a Sales position is to know things like insurance, equipment, and so on. You might think they don't "care" about the money, but see what happens when they don't get paid!

Based on "my" personal experience with DME's, you will find this site will provide you with more accurate information about your equipment than a DME will give you. I know for a fact that you will get more help with therapy issues here. If you don't feel comfortable with advice here, at least you can learn what might help and then take those questions to your Doctor and let them change your settings.

[palerider]

I would rather not make statements of "all" unless I had done a good bit of research to be sure it is really true. In addition, it would be true if the savings was not minimal. And I am not sure how I would define minimal savings should translate.

Anyway, one of the posters suggested that the price from an online DME would always be less than buying through one's insurance. Insurance where one would only need to meet the price of a deductible, and then (probably) 13 co-payments. I would not want to make a purchase right after January first because that, for me, would be the maximum deductible. Whereas if I go to the regular doc, and he does standard blood tests, where the clinic system writes off the deductible. The DME might be less inclined to write off my yearly deductible. Which does not make it more likely that I will pay the four hundred something dollar deductible which the 'not in the real world' Congress has allowed for a beginning of the year deductible for Medicare.

I did want to leave the OP with one thought about dealing with a DME. The person who answers the phone at a DME is only meant to answer the phone, and likely can not tell you very much. The workers in the local DME office will say, until I can get all you personal information, and see about signing you up, then I can not do much for you but give advice. The machine you get depends on what your doctor wrote on the prescription, what you will be expected to pay depends on your insurance. In any case, those in my local DME office only try to help me with my therapy, the logistics of getting supplies. Anything to do with money is handled by an office in Florida. I would bet, that if you did not have insurance, they still could find a way to get a better price for a machine than the list the manufacturer has them say it is to be. Just the company is not going to say so known easily. I would guess they have an insurer who only contributes a price negotiation. Exactly what my local pharmacy does on some drugs. I am not sure the DME would do that.

Just I have seen those come on the forum breathing fire because the first person on the phone from the DME can not give them detailed information on what the customer has to pay when. Guys, they only answer the phone. They are not insurance experts or RT's or mind readers (know all about what your individual case needs.) Most of the second line of people only want to help me with my treatment. They do not know or care about the money part. They just try to help me use my machine.

Probably best to just ignore all the above somewhat incoherent rambling.

Btw, local DME "list prices" have nothing at all to do with what the mfgr says the price should be... mfgr set prices are what usually show up with online cpap sellers, which are a fraction of the local DME 'pie in the sky' price.

[ChicagoGranny]

Probably best to just ignore all the above somewhat incoherent rambling.

https://www.youtube.com/watch?v=fjwWjx7Cw8I

Best wishes for the New Year!

[purple22]

The first person to answer the phone is usually not an expert on anything, unless they are subbing for the receptionist. The feelings some have here about DME's is both about expectation, and how they treat the DME Personnel. At least my experience has always been like I described here. DME's are competent and professional and caring. I do believe that many of you have had different experiences. Any company that hires people for low wages has a lot of personnel who might not be helpful.