anyone else have aetna ppo?
6 posts
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sleepless in ny
- Posts: 15
- Joined: Sun May 01, 2005 1:36 pm
- Location: upstate ny..but not new york city
anyone else have aetna ppo?
Does anyone else have aetna ppo? I am scheduled to get fitted for my cpap at my local dme on Thursday morning at 10:00am. The dme called me this morning and said they had contacted aetna and that they only pay 80% of my cpap..and that does not include a heated humidifier. I don't have a choice of machines either. I get whichever one the dme gives me. Does that sound right? I was under the impression that my insurance would pay 100% of any device that was medically necessary. I tried to call them, but they were already closed for the day. This is frustrating already. My portion of the payment is $96.00
If life is a bowl of cherries what am I doing in the pits? Remstar Pro C-flex Heated Humidifer,, Mirage Swift Nasal pillow system
Many on the board have expressed regret that they went through their DME/insurance and THEN found cpaptalk.com. Good timing!
I strongly suggest taking the following steps:
1. Hang around here, read old posts, and learn what CPAP gear works for real live humans.
2. Check out cpap.com. The stuff on their front page is either new, good or both.
Specifically, I'd check out
CPAP Machines: 420G (light, cheap), 420E (light auto) Remstar Auto with C-Flex (decked out auto that also works as a CPAP if all the buzz on the board lately ends up to be true)
3. Do the math.
If your not getting your choice of equipment then odds are you are going to walk away with some real junk (Remstar Lite, S7 Lightweight), or you will walk away without a heated humidifier. And you won't get software for sure.
This means that you will get 80% coverage on stuff that may work for you, but probably won't. On the up side, someone else does pay for 80%!
The other side of the coin is buying online.
I've plugged cpap.com here because I like them and because they support the board we're talking on. You can choose whatever you want going through them. So if you hang around here and purchase off what you hear you have a much better chance of buying more high level equipment. Higher level equipment works most of the time. You can also call up cpap.com, tell them what features are most important to you (price, auto, heated, good software support, etc, etc) and they'll give you good suggestions.
Why do the math as a title to this? Well, just about all the board members here seem to have followed this pattern:
1. Get setup on junk from a DME
2. Be unhappy with it and end up here
3. Find out that there is much better equipment if they bypass the DME and deal with online cpap companies
4. Find out what they really need (vs what insurance or their doc says)
5. Buy it online
This means that they've wasted time dealing with the DME. Money paying copays. Time chatting to find out what was the best. Money buying it all from cpap.com.
You've got to do a few of the above, but if I'm you, I'm finding out what is better here, finding out what it costs, going into the DME and demanding that equipment or walking out and getting it online.
I strongly suggest taking the following steps:
1. Hang around here, read old posts, and learn what CPAP gear works for real live humans.
2. Check out cpap.com. The stuff on their front page is either new, good or both.
Specifically, I'd check out
CPAP Machines: 420G (light, cheap), 420E (light auto) Remstar Auto with C-Flex (decked out auto that also works as a CPAP if all the buzz on the board lately ends up to be true)
3. Do the math.
If your not getting your choice of equipment then odds are you are going to walk away with some real junk (Remstar Lite, S7 Lightweight), or you will walk away without a heated humidifier. And you won't get software for sure.
This means that you will get 80% coverage on stuff that may work for you, but probably won't. On the up side, someone else does pay for 80%!
The other side of the coin is buying online.
I've plugged cpap.com here because I like them and because they support the board we're talking on. You can choose whatever you want going through them. So if you hang around here and purchase off what you hear you have a much better chance of buying more high level equipment. Higher level equipment works most of the time. You can also call up cpap.com, tell them what features are most important to you (price, auto, heated, good software support, etc, etc) and they'll give you good suggestions.
Why do the math as a title to this? Well, just about all the board members here seem to have followed this pattern:
1. Get setup on junk from a DME
2. Be unhappy with it and end up here
3. Find out that there is much better equipment if they bypass the DME and deal with online cpap companies
4. Find out what they really need (vs what insurance or their doc says)
5. Buy it online
This means that they've wasted time dealing with the DME. Money paying copays. Time chatting to find out what was the best. Money buying it all from cpap.com.
You've got to do a few of the above, but if I'm you, I'm finding out what is better here, finding out what it costs, going into the DME and demanding that equipment or walking out and getting it online.
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sleepless in ny
- Posts: 15
- Joined: Sun May 01, 2005 1:36 pm
- Location: upstate ny..but not new york city
Limpy,
If I buy it online will my insurance company reimburse me? Money is tight with me right now, but if it means getting AT LEAST one good night sleep I could find a way to do it
If I buy it online will my insurance company reimburse me? Money is tight with me right now, but if it means getting AT LEAST one good night sleep I could find a way to do it
If life is a bowl of cherries what am I doing in the pits? Remstar Pro C-flex Heated Humidifer,, Mirage Swift Nasal pillow system
Sleepless,
I have not done this myself, but have lurked as others on the board went through it. From what I gather, you have to do some homework as the repay rate varies by insurance carrier. Call them up and find out what they'll do for you if go direct. It will be a hell of a fight to get an APAP or a Heated Humidifier out of them, but people have done it.
I do know that cpap.com gives you an invoice that contains an itemized list of the items you purchased, their price and their billing codes. I'm pretty sure other online companies do as well.
Sorry I couldnt be of more help. Has anyone one the board danced with AETNA PPO before?
I have not done this myself, but have lurked as others on the board went through it. From what I gather, you have to do some homework as the repay rate varies by insurance carrier. Call them up and find out what they'll do for you if go direct. It will be a hell of a fight to get an APAP or a Heated Humidifier out of them, but people have done it.
I do know that cpap.com gives you an invoice that contains an itemized list of the items you purchased, their price and their billing codes. I'm pretty sure other online companies do as well.
Sorry I couldnt be of more help. Has anyone one the board danced with AETNA PPO before?
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Guest
Sleepless (and others):
I just noticed this post after writing a long reply that's directly on point in another thread:
viewtopic.php?t=3728&highlight=aetna
Sleepless, did you resolve anything since your last post? Any advice for me?
Thanks.
I just noticed this post after writing a long reply that's directly on point in another thread:
viewtopic.php?t=3728&highlight=aetna
Sleepless, did you resolve anything since your last post? Any advice for me?
Thanks.
6 posts
• Page 1 of 1