Good bye DME!!

[tsduke]

Returned my Dreamstation Bipap S/T to the home medical provider today and...man, did it feel good to wash my hands of any relationship with them! DME asked me why and I told them I saved thousands buying one elsewhere. Of course they again gave me the BS line that no headgear would be covered since insurance didn’t pay for machine, but I had already researched with BCBSIL and that is not true. I’m finding I won’t be replacing masks very often anyway and will just order online so it doesn’t matter anyway really.

After buying an ASV on my own outside insurance a couple months ago I could have returned it earlier, but held onto it through end of year since my insurance out of pockets were met for 2019. That way I could be sure the ASV would work. Still hoping to wake up less from rising pressure, but always well under 1 AHI, and even a couple of 0 days which I once thought impossible.

Thanks to all cpap talk members for the support to get where I’m at today!

[zonker]

Returned my Dreamstation Bipap S/T to the home medical provider today and...man, did it feel good to wash my hands of any relationship with them! DME asked me why and I told them I saved thousands buying one elsewhere. Of course they again gave me the BS line that no headgear would be covered since insurance didn’t pay for machine, but I had already researched with BCBSIL and that is not true. I’m finding I won’t be replacing masks very often anyway and will just order online so it doesn’t matter anyway really.

After buying an ASV on my own outside insurance a couple months ago I could have returned it earlier, but held onto it through end of year since my insurance out of pockets were met for 2019. That way I could be sure the ASV would work. Still hoping to wake up less from rising pressure, but always well under 1 AHI, and even a couple of 0 days which I once thought impossible.

Thanks to all cpap talk members for the support to get where I’m at today!

congrats-sparkle.gif

(how long will it take before affronted newbie comes in to tell us insurance is a good thing and how dare you go outside of it?)

[zorki1c]

All depends on your situation. We are on Medicare and definitely can get our gear cheaper through our DME than buying it somewhere else.

[chunkyfrog]

Depending on your Medicare supplement, cpap costs can be as little as ZERO!
This is what I pay. (Outside of my considerable premiums.)

[Becca8104]

I prefer using insurance & a DME & sticking to the routine replacement schedule & paying 20% out of pocket, but that's because I can afford to do so. In 5 years I will be forced onto Medicare. My opinion & payment options may change in the future. There may be a time in my life when I can't afford the 20% and decide to replace my equipment less often or just skip using insurance & a DME. Everybody has to do their own thing their own way. Not everyone has insurance and even those with insurance may not want to use it because of their own reasons. I am squeamish about buying "used" or gently used" equipment, but that is just me. I hope I can continue to afford my 20% portion for the rest of my life, but you never know what the future holds. Life could bite me in the butt & a financial disaster could happen & I will be forced to be frugal.

[tsduke]

20% for me through DME is way higher cost than buying outright. My machine was $650 for 10 months. So $6500 total and with my insurance it would be $3500 just for the machine if that was the only thing billed in the year. I can buy new machine from second wind for $2149 or $1749 used. Other even cheaper options exist like watching on this forum which I did. For gear I can buy a complete mask online for not much more than only buying a cushion through insurance sand DME.

I do agree it will differ for everyone dependent on circumstances. For me the only time going through insurance would matter is in a year where I need a lot of other care like a surgery. My DME is a bunch of liars so that played a role for me too.

[palerider]

I prefer using insurance & a DME & sticking to the routine replacement schedule.

The "replacement schedule" is a fabrication of greedy DMEs, who looked at the minimum intervals that Medicare set, and was copied by most insurance companies, and said "ya know, if we tell gullible people to throw away perfectly good masks and hoses and such, and buy more on this "schedule", WE'LL MAKE MORE MONEY!!

And, thus, your routine replacement schedule was born.

In 5 years I will be forced onto Medicare.

See above.

[tsduke]

Great point on the schedule.

Since I settled on a mask in September I’ve not needed to replace a thing. All components working as good as ever and it looks like it will last awhile yet. Actually mask works better than early on as I’ve learned how to better manage fit.

[palerider]

Great point on the schedule.

Since I settled on a mask in September I’ve not needed to replace a thing. All components working as good as ever and it looks like it will last awhile yet. Actually mask works better than early on as I’ve learned how to better manage fit.

Yeah, the only reason to replace things on a schedule is if you like helping to fill up the landfills with plastics.

[chunkyfrog]

Or partially recoup the premiums . . .

[SheitlQueen]

I just ordered a replacement heated hose, a new cushion, and two new filters from the DME. I don't know what Medicare actually covers, but the invoice that came with the equipment came to $184.94. I looked on Amazon and saw I could purchase the exact same items for $83. I use the DME because Medicare and my supplement cover the entire costs, where as ordering from Amazon would cost me out of pocket. It's a shame the government and insurance companies don't get together with Amazon to allow us to order supplies there. Sure would save them a lot of money.

[Becca8104]

My machine cost me a one time fee of $175.00 (my 20%) and I continue to pay 20% every time I get new supplies, so I feel the cost is reasonable. I never considered trying to buy equipment out of pocket. Again, I guess I never considered NOT using insurance or following their "schedule". I use CPAP Military Medical for my DME. Tricare (Humana Military), has picky rules. I am not sure they will pay their 80% if I don't comply to what has been set up already. I was told by my sleep doctor that I must use My Air in order for Tricare to continue paying the 80% because I have to "prove" compliance before they will pay. Maybe people with Tricare coverage for CPAP all get prescribed Resmed AirSense 10 machines so that My Air can be used and they don't have any other choice? I really need to ask questions I think. I was also told that when I get on Medicare, Medicare also "requires" proof of compliance before they pay. Does Medicare really peek at your My Air results? for that matter, does Humana do the same? If what I was told is true, what do users of Dreamstation & other machines do for compliance proof? I am beginning to think that it may be a lie all around regarding "proof of compliance". Does anyone know the real answer?

[SheitlQueen]

I was told that when I get on Medicare, Medicare also "requires" proof of compliance before they pay. Does Medicare really peek at your My Air results? for that matter, does Humana do the same? If what I was told is true, what do users of Dreamstation & other machines do for compliance proof? I am beginning to think that it may be a lie all around regarding "proof of compliance". Does anyone know the real answer?

I just went through the compliance appointment with my doctor. It has to be done between 31 and 90 days after you get your machine. They down load the data off of your machine to verify usage compliance (using it 70% of the time for a 30 day time frame) and also document if your symptoms have improved. Your doctor documents your compliance for Medicare, I don't think they send the actual data.

[palerider]

Well, you know the old saying.. "There's LIES, and there's DAMN LIES, and then there's THE BULLS*HIT that doctors and DMEs tell their patients.

I was told by my sleep doctor that I must use My Air in order for Tricare to continue paying the 80%

This would be the latter. MyAir, worthless thing that it is, is nothing but a web page that views the data that's been transmitted to the Resmed servers. The DMEs and doctors don't use MyAir...because it's worthless. They use AirView, or another system that displays detailed data, (though not the high-rate breathing and pressure data that Oscar displays).

because I have to "prove" compliance before they will pay.

Most insurance wants to know that you're using the machine, or they'll quit paying for the machine. A few want you to continue to prove usage before paying for the mostly needless flood of "supplies". So, this one is a 'maybe'.

I was also told that when I get on Medicare, Medicare also "requires" proof of compliance before they pay.

If you're a new user, but that's been detailed elsewhere.

Does Medicare really peek at your My Air results? for that matter, does Humana do the same?

No insurance company does... (well, maybe Kaiser, sort of), the DME does, then they tell the insurance companies (or Medicare) "yup, they're using it, GIVE US MORE MONEY".

If what I was told is true, what do users of Dreamstation & other machines do for compliance proof?

They either take in their SD card (surprise, yours should have one too), OR they use a plugin cell modem.

Every single CPAP made in ... I dunno, at least the last 20 years, probably more, tracks usage for compliance.

I am beginning to think that it may be a lie all around regarding "proof of compliance". Does anyone know the real answer?

Proof of compliance is real... having to use 'myair' is BS.

[Stephaniedp3]

My DME charged $107 for the first appointment and like $43 a month for 10 months. If I’m compliant for 10 months the insurance will pay the remainder and the machine is mine. Unsure what new supplies would cost because I’ve had it less than 2 weeks.