Insurance vs self pay

[Pugsy]

DME's lie like snakes anyway. So I would never, EVER, trust a DME who tells me what the out of pocket cost is going to be, if they ever would. ALWAYS check with your insurer.

Totally agree but to my thinking if I go to a DME that my insurance recommends they damn well should at least make an attempt to answer my questions (which I would then of course verify with the insurance company) and make a damn phone call if they can't answer the question.
If they aren't willing to make a simple phone call....pretty sorry DME and like I said...run don't walk away from that sort of service.
There's someone in their billing department whose job it is to figure this stuff out....and if there isn't...another reason to go elsewhere.

I would also report to the insurance company the level of non service I got from someone they recommended I go to and maybe they should reconsider recommending them.

When I get on my high horse for the principal of the thing I can ride it a long way. Will it make any difference??? Probably not but I would sleep better knowing I ratted on the crappy DME.

I can understand not knowing....but what is unforgivable to me is lack of trying to find out whatever it is they don't know.
Obviously a don't give a crap mentality there....would make me wonder what else they don't give a crap about.
I wouldn't buy so much as a filter from a place like that.

[TheWalkman]

My old CPAP is 10 years old and having finally reached my insurance deductible for 2021, I thought this would be a good time to get a new CPAP. Wrong!

The insurance company (Cigna) makes you jump through so many hoops (and requires you to rent the machine for six months, have a new sleep study, visit your doc for another check-up, etc.) it would likely cost more for me to have them pay for a new machine than if I paid for it out of pocket.

(From what little I can tell, they would reimburse me around $100 before my deductible gets reset on December 31, making the insurance claim a real joke.)

This assumes I could even buy a new machine before the end of the year which seems impossible due to the Philips fiasco.

I did my homework and it appears that the new ResMed 11 is a nice machine but I can't get a straight answer from any DME on what the cash price would be.

Has anyone gotten a cash price for the new ResMed 11?

I've never seen an industry where no one seems to have a clue about anything. Very frustrating.

[GrumpyHere]

Has anyone gotten a cash price for the new ResMed 11?

$1000 per garagelogician

Two weeks ago I found a DME that was selling the AS11 online for preorder, and the website said that the units would start shipping at the end of September. I placed an order, and they notified me that the order was processed and they attached my prescription to my reserved unit, and that they would ship it out once ResMed approved them for online sale. Later that day, the preorder page was updated to say that they would not ship until Jan 2022, and by the end of the day the preorder listing had been removed entirely. I've contacted the DME regarding this and they didn't have any firm date on when ResMed would allow my unit to be shipped...they only assured me that it would be sent out as soon as possible (and they did offer to sell me an AS10 instead).

Did they get your money?

Yeah, I paid $999 for it. They've been super responsive, so I'm not worried about it at all. At least I know the unit has been reserved for me and will be shipped out as soon as ResMed gives them the OK. I'm not going to go through insurance and all that BS in order to get one sooner.

If my AS10 dies before I get the AS11...I guess I'll break out the tools and yank the foam out of the Dreamstation.

But there is a much better deal via a new Aircurve 10 VAutos in black (rather than the usual white/silver) for $950 from a seller on DotMed if "For Her" algorithm doesn't matter for you.

https://www.dotmed.com/listing/bi-level ... ew/3650482

https://www.dotmed.com/listing/bi-level ... ew/3650483

[Janknitz]

I did my homework and it appears that the new ResMed 11 is a nice machine but I can't get a straight answer from any DME on what the cash price would be.

Has anyone gotten a cash price for the new ResMed 11?

I've never seen an industry where no one seems to have a clue about anything. Very frustrating.

IF you intend to pay out of pocket, don't expect a fair price from a DME. And they may not have 11's yet. They don't seem to be in wide circulation in the US right now.

If you can "make do" with a ResMed 10 Autoset, our hosts at cpap.com have them ready to ship and the price is published right there $1099.99. If you join their newsletter you get 15% off, around $935. And used ones in great condition abound, some aren't even really "used". This is an excellent machine and will be a significant upgrade from a 10 year old anything.

You may have to wait a bit for online suppliers to start carrying ResMed 11's.

[garagelogician]

IF you intend to pay out of pocket, don't expect a fair price from a DME. And they may not have 11's yet. They don't seem to be in wide circulation in the US right now.

I've spoken with several local brick and mortar DME's. Those that have the AS11 in-stock (or on order) specifically state that they are being "designated for specific patients that need a machine." I got an email from one DME that said, "We are unable to dispense these machines as out of pocket payments at this time. Due to the recall causing a worldwide shortage, we have to reserve them for new patients going through insurance or for the patients that are able to get a replacement machine through insurance."

I'm getting pretty steamed about this. This is just a money grab for Resmed, the DMEs and the insurance companies. I realize that I can purchase an AS10 from numerous places (including the host here)...but I don't want to buy an outdated machine with a track record of noisy motors (including my own which is too noisy to use now). So as a self-pay patient...my option is to either buy a machine I don't want, continue to inhale VOCs from my recalled Phillips unit, remove the foam, or go without treatment.

[chunkyfrog]

Cpap.com can charge less than DMEs because they do not "do" insurance.
Insurance/Medicare force dealers to contend with
MOUNTAINS OF PAPERWORK.
For sure, it does not balance out with the price,
but there is also payroll, location, licensing, and contracted fine print with suppliers.
I watch MY bottom line, and accept only what I order.

[crshirley7]

Initially I went the insurance route. My deductible is so high that I ended up paying more (the machine itself was $1800) than if I just payed out of pocket. For example: for a new mask replacement, the DME charges $120, insurance adjusts it down to $59 but I can get the same thing on Amazon for $21 out of pocket. When Phillips did the recall I ended up returning the machine to the DME, and buying a Resmed online out of pocket. Cost $800 ish... It cost less than a new phone or laptop computer...and a lot less hassle of trying to keep up with the supply schedule. In the end it is about my health not what I can save (or not) by using insurance....So I advocate strongly for out of pocket with the exception if you need the help that the DME provides, then go that route...
Just saying...

[Janknitz]

I've spoken with several local brick and mortar DME's. Those that have the AS11 in-stock (or on order) specifically state that they are being "designated for specific patients that need a machine." I got an email from one DME that said, "We are unable to dispense these machines as out of pocket payments at this time. Due to the recall causing a worldwide shortage, we have to reserve them for new patients going through insurance or for the patients that are able to get a replacement machine through insurance."

What am I missing here?

• You met your insurance deductible and you CAN get your insurer to cover a new machine. You are "able to get a replacement machine through insurance.
  
  You have contacted DME's who DO have the AS11 and WILL dispense it to "patients that are able to get a replacement machine through insurance".

So where's the problem????

[chunkyfrog]

Are you not on some "master list"?
Is that what is stopping them?
Sounds fishy to me.

[hairfallingout]

If I had the money I’d self pay. Well I do but chose to go through insurance. Already know it’s going to be headaches. I gotta call Monday to have pressure turned up a lot and a couple other things. I know how to do it myself but am Leary to go into the machine. If I didn’t have this older machine as a backup I’d adjust it myself for sure. Pay out of pocket the people here will get you dialed in way faster then any doctor.

[Janknitz]

I gotta call Monday to have pressure turned up a lot and a couple other things. I know how to do it myself but am Leary to go into the machine. If I didn’t have this older machine as a backup I’d adjust it myself for sure.

Are you worried about adjusting the pressure will affect your compliance data on a new machine? Won't happen. All they care about is compliance data--hours of use. You can't change that. The insurer doesn't give a flying flip about the efficacy of the treatment, what pressure you are at, etc.

And if you do know how to make changes, that's the fastest "help" of all. You aren't "going in to the machine". You are just changing the settings. Nothing permanent, nothing that would harm the machine.

[Pugsy]

He was told the usual lie DMEs tell people..."it's against the law for you to change anything and if you do then your insurance won't pay for the machine and thus YOU will have to pay for it"....he's on Medicaid and obviously can't afford to pay so they scared the bejesus out of him. He knows how to change stuff....but is simply too afraid at this point.

[Janknitz]

He was told the usual lie DMEs tell people..."it's against the law for you to change anything and if you do then your insurance won't pay for the machine and thus YOU will have to pay for it"....he's on Medicaid and obviously can't afford to pay so they scared the bejesus out of him. He knows how to change stuff....but is simply too afraid at this point.

Oh, I see.

[D.H.]

For me, the price to rent for thirteen months and then buy was considerably cheaper than buying off-insurance. I was not old enough for medicare at the time (I am now), but I did have decent insurance.

This presupposes that I would need an overnight sleep test (to get a prescription) in either case. This seems to be a medicare requirement and is mimicked by most private insurers in the US.

Getting a machine off-insurance with no prescription is not - strictly speaking - legitimate, but it probably can be done.

Since, that machine was recalled, I now have a spanking-new DS2 machine at not cost to me or medicare (as far as I 'm aware).

Assuming no recall on the DS2, this machine should last for at least five years. I was anxious to replace the DS1 anyhow (at least before the pandemic), since I was afraid to the machine breaking down while I'm traveling outside the country. Since the pandemic put a damper on travel plans, it was not as big of an issue.

[hairfallingout]

He was told the usual lie DMEs tell people..."it's against the law for you to change anything and if you do then your insurance won't pay for the machine and thus YOU will have to pay for it"....he's on Medicaid and obviously can't afford to pay so they scared the bejesus out of him. He knows how to change stuff....but is simply too afraid at this point.

So when I called Monday and told the DME the settings I wanted to get it closer to what my bipap setting are at as this is a airsense 11 and I have the dreamstation. I asked about the patient view which is called simple and advanced. The DME played it off like it didn’t have that. I said I downloaded the clinician guide and it does. She said I could change it. I said I have to go into the setting to do so are you giving me permission to do so she said yes. I realized at that moment she lied and doesn’t care and I think she was intimidated by me as I knew more about the machine then her. It’s on now I’ll change it to what I need which I lowered the pressure as her setting was to high.

Now I do wonder what is compliance if it’s 4 hours that means I need to use less?? I would like to play them as I want a freaking bipap. It’s tuff going from a Ferrari to a ford Pinto