No more renting

[SimplyMario725]

Sick of renting, does anyone think can anyone own their own cpap machine instead of being bombed with rental fees?

[bdp522]

Most of us own our machines. My insurance required rental for 3 months(with proof of compliance) then purchased it outright. You can also purchase your own machine. Check with your insurance to see what your coverage is.

Brenda

[packitin]

I have Medicare, and they told me whether I rent or buy, I pay the same for 10 months, then decide if I want to buy it.
So I then pay 3 more months to buy it. Since I pay $102.73 /mon. that comes to $1335 for the cost (except for the deductible, I hope Medicare pays it). But I see on the Internet, that the machine I'm going to get sells for $845. Good gosh, they (DME) are really making a nice profit, aren't they?
Jay

[Slinky]

OUCH, PackInIn!!! WHAT are you paying $102 a month for?

Medicare reimbursement has dropped since I got my Resmed but so has the Medicare Allowed and your 20% copay should only be 20% of the ALLOWED amount, NOT the Billed amount! Medicare purchases everything else but the xPAP itself outright at time of provision so your monthly should ONLY be that 20% of the Allowed amount for the CPAP. Here's my 2006 figures for just the CPAP monthly rental for 13 months:

Billed: $135.00 - Allowed $99.95 - Medicare Paid $79.96 - CoPay $19.99

Here's the figures for the purchase of the rest of the equipment:

Billed $548.00 - Allowed $499.63 - Medicare Paid $399.70 - CoPay $99.93

And here is the individual item cost breakdown:

a7037 - tubing used with positive airway pressure device - Allowed $48.00 - Medicare Paid $32.82
a7034 - nasal interface (mask or cannula type) used with positive airway pressure device, with or wi - Allowed $130.00 - Medicare Paid $94.11
a7035 - headgear used with positive airway pressure device - Allowed $45.00 - Medicare Paid $31.80
e0562 - humidifier, heated, used with positive airway pressure device - Allowed $325.00 - Medicare Paid $240.97

[packitin]

Thanks Slinky,
I've got to call them back and get more information. I haven't quite figured out all this yet. I'll use the information you gave me to ask them some questions about exactly what I'm paying for. It wasn't clear at all to me in the first place.
I'm really seriously playing now with the idea of just buying my own machine. I may just look seriously at the Vantage II.
Jay

[Wulfman]

Sick of renting, does anyone think can anyone own their own cpap machine instead of being bombed with rental fees?

I've never rented or had to rent a machine. I purchased all of mine (4) out-of-pocket.......insurance provider reimbursed me for 80% of the cost of my first one. I did the math and came to the conclusion that I could buy what I wanted (better equipment from CPAP.com) for about what my co-pay would be be renting for 10 months and the other 80% would have been wasted.

Den

[Slinky]

I can't help you out w/2008 payments and reimbursements because I've been switched to a bi-level and the figures wouldn't jive at all.

However, in 2007 whilst my CPAP was still under the capped rental the Medicare reimbursements dropped (they have in 2008 too) and here are the 2007 monthly rental figures:

Billed $135.00 - Allowed $74.96 - Medicare Paid $59.97 - CoPay $14.99

Here is a mask in 2008 but I don't remember if there is a difference in mask style prices nor which mask this was:

Billed $199.40 - Allowed $157.39 - Medicare Paid $125.91 - CoPay $31.48

It would have been for either the Resmed Mirage Quattro (full face) or the Resmed Mirage Micro (nasal cushion)

Since you are on Medicare have you signed up at mymedicare.gov?? You can check all your claims once you are registered at the site. Registration takes several days as they insist on verifying and then snail mailing your registration information before you are granted access.

[packitin]

Again, thank you so much. I couldn't do it without you.
Jay

[Slinky]

Oh, yeah, you could!!! It just takes a while to encounter and learn this stuff. I sure didn't know ANY of it when I started on this journey!!!! And I made some mistakes. Boy! Did I make some mistakes. But, hey, live and learn!

[packitin]

Well, when I logged into the Medicare Site, here is what I have recorded so far.
(By the way, thanks for giving me the URL for the site)
Do these figures look about right?

Service End Date Amount Chrged Medicare Apprvd Provider Paid Billed Claim Type
8/19/08 $89.00 $40.87 $32.70 $8.17 PartB
8/4/08 $3,368.75 $3,368.75 $419.89 $250.82 Outpatient

8/4/08 is when I stayed all night for the study. Yikes, $3368 for a night of h**l. I told the attendant that he'd better bring me a cup of coffee the next morning, or I'd take hostages. Well, he did, and that was the best cup I've ever had. I left before 6 AM before the sun came up. He asked if I could drive home. Well, the nerve, I could have driven anywhere to get out of there.
cheers,
Jay

[Slinky]

Wow! That was one h*ll of an expensive sleep evaluation or titration!!!! Or was that for two nights, one in-lab evaluation and one in-lab titration?

Did you click on the Claim Number to go to the Claim Details page and scroll down to the bottom of the Claims Detail page to see the Procedure Details?? Most likely that will include both studies: evaluation and titration.

And, no, it doesn't look right that Medicare allowed the full billed amount.

Here's my 2008 sleep evaluation and bi-level titration:

Billed $3,850.00 - Allowed $1,605.16 - Medicare Paid $1,284.13 - CoPay $321.03

Procedure Details
Claim Line Number: 1 Provider Number: xxxxxxx
Status: Approved and paid Place of Service: 11 - Office
Date of Service Start Date: x/x/2008 Amount Charged: $1,850.00
Date of Service End Date: x/x/2008 Medicare Approved: $765.04
Procedure Code: 95810 - Polysomnography; Sleep Staging With 4 Or More Additional Parameters Of Sleep, Attended By A
Medicare Paid $612.03

Procedure Details
Claim Line Number: 2 Provider Number: xxxxxxx
Status: Approved and paid Place of Service: 11 - Office
Date of Service Start Date: xx/xx/2008 Amount Charged: $2,000.00
Date of Service End Date: xx/xx/2008 Medicare Approved: $840.12
Procedure Code: 95811 - Polysomnography; Sleep Staging With 4 Or More Additional Parameters Of Sleep, With Initiatio
Medicare Paid $672.10

I don't know if a bi-level titration is more expensive than a CPAP titration or if the diffrence in amounts is due to different areas of the country. The country is split into 3-4 different regions if I remember correctly.

[yorkiemum01]

Can I relate..........I've learned an EXPENSIVE lesson this year.
Sleep studies (multiple) $3300.00.....CPAP rental and equiptment, all
applied to deductible......$275 for mask, (bought second one online cash $89.00),
hose/filters $99.00, rental of machine $111.99 for last 8 months.....and my
group health insurance plan doesnt consider it 'paid for' until 14 month rental.
Awww...the $$$ was killing me, so found a private seller and bought outright this
month,once I knew for sure WHICH machine was best suited for me.
What a ride its been.

[packitin]

Here is what I saw when I clicked on the claim no.
And yes, that was for one night only. Does that seem to be a little high?
I wonder what I'd do if I had to go to the hospital for a week.


Claim Line Number: 1 Date of Service Start Date: 8/4/2008
Procedure Code: 95810 - polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a Revenue Code: 0740 - General Classification EEG
Medicare Approved: $3,368.75 Amount Charged: $3,368.75
Total Units: 1 Covered Units: 1

Procedure Details
Claim Line Number: 2 Date of Service Start Date:
Procedure Code: Revenue Code: 0001 - Total Charges
Medicare Approved: $3,368.75 Amount Charged: $3,368.75

[Slinky]

Wellll, "they" do say that a PSG done at a hospital sleep lab is more expensive than a free standing sleep lab PSG ... can I assume yours was done at a hospital sleep lab? WHEW! That sure is a lotta moolah for one night!!!

[Linus]

My company last year had okay benefits. This year they changed to include a large deductible. I rushed my equipment. I called my insurance provider and asked that the machine be converted to sale right away before my DME got involved. With the doctor's approval it happened. I would have been stuck renting the machine for 3 months and then having to buy the unit under reduced benefits this year.

Last year the machine cost me $400.00. This year I would have spent close to $1000.