SURVEY How much did you Pay using Insurance & a DME?

th · Post by th » Sat Aug 13, 2005 12:37 pm

I am curious how everyone else did using their insurance and a DME....... below is mine

Here is what I paid for a S7 Resmed Cpap and a F&P 150 heated humidifier and one Swift mask

My Insurance is UHC & the DME is Apria

For CPAP equipment UHC has a $1000.00 deductible and then they (UHC) will pay 80%.If you go out of network then the deductible is $2000.00. I would say I have good insurance. UHC paid for both sleep studies and I paid nothing. I stayed in the network and the only DME that had a contract with UHC was Apria.

Here are the bills I paid to Apria

Jan 13 2005 $156.70 +
$ 68.02
Feb 13 $ 187.26
Mar 13 $ 204.84
Apr 13 $ 411.98

Total I paid $1,028.80

Online S7 $435 + F&P 150 $179 + Swift $115 for a total of $729

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, humidifier, swift, CPAP, DME

Guest · Post by **Guest** » Sat Aug 13, 2005 1:24 pm

Another insurance rip off...
1 cpap
1 activa mask
1 chin strap

$1200.00 insurance + 220.00 my copay = $1420.00

Guest · Post by **Guest** » Sat Aug 13, 2005 1:32 pm

forgot to add...

online price for these three products would have been under $600.00

Isn't there something shamefully wrong with this picture?

yawn · Post by **yawn** » Sat Aug 13, 2005 4:24 pm

My insurance (Encore) is renting the machine (I don't know how long they do this). If I'm successful, they will eventually purchase it.
The 1st month, my out-of-pocket was $60
This month, I'm paying $10.
I have to figure out what my hardware would cost if I bought it on-line vs. what my insurance will pay through my DME (Lincare).

wading thru the muck! · Post by **wading thru the muck!** » Sat Aug 13, 2005 6:05 pm

th,

Great thread. We've been suggesting this in other threads for a long time, but this gives people actual data. This just reinforces that for many people skipping the insurance company and just paying out of pocket from an online provider is the best route. Of course my online provider of choice is cpap.com.

napper · Post by **napper** » Sat Aug 13, 2005 6:18 pm

My insurance company paid 100% for everything! I was suspicious of their generosity but later when I read the statement breaking down what was paid to the DME I was taken back on the discrepancy between what the DME was charging (similar to cpap.com) and what the insurance company has contracted to pay - A major markdown! I am over due for a new mask - but am leaning towards a swift nasal mask - any thoughts?

Equipment: BiPAP Pro 2 with Remstar Heated Humidifier with Profile Lite Gel Mask

Sleepless on LI · Post by **Sleepless on LI** » Sat Aug 13, 2005 6:24 pm

I have been truly blessed. Although I am self-insured for health benefits through Empire Bluecross/Blueshield and pay a bill for myself for an HMO of over $500 a month, they did right by me when it came to being diagnosed and whatever came after.

I have had absolutely no out-of-pocket for anything so far, not the first month machine rental or the one they bought for me at the end of the second month. They even gave me two masks within the first two weeks for nothing out-of-pocket since my first one, the Oracle, was a bust. My DME is Apria and they threw in the second mask as a courtesy.

So far, my only out-of-pocket has been to purchase two additional masks, the Breeze and the Swift, and all associated items for help, like my Target pillow, my Tempur-Pedic pillow, my J&J medical tape, my Tegaderm patches and my mouth guards, but those were of my own choosing. And I just ordered Dr. Sue's Nose Breathe mouth guard.

Like I said, I have been very fortunate to have these benefits cover it all for me.

th · Post by th » Sat Aug 13, 2005 6:32 pm

Wader, my wife( lh) has the same insurance(UHC) and would have had Apria has her DME. But her deductible was $2000.00 in network for her . I ordered online for her. And I wish I would have done the same for me. When I ask my DME what my cost would be they (DME) told me they could not tell until the final bill would come due in April, but for me not to worry since I had good insurance th

[quote="wading thru the muck!"]th,

Great thread. We've been suggesting this in other threads for a long time, but this gives people actual data. This just reinforces that for many people skipping the insurance company and just paying out of pocket from an online provider is the best route. Of course my online provider of choice is cpap.com.

ITeach · Post by **ITeach** » Sun Aug 14, 2005 7:26 am

I am feeling really blessed as I read your posts. My insurance (an HMO I might add) has paid 100% of everything. I can even get a new mask/headgear/tubing every 3 months. The only out-of-pocket expense I've had is my 2 $25 copays to the neurologist/sleep doc.

th · Post by th » Sun Aug 14, 2005 8:03 am

Well, I am glad I posted. It looks like I have sorry insurance. Every year we hear the same song and dance(from my company I work for) on how good our insurance is as they(the Co.) raise the premiums on us
th

Janelle · Post by **Janelle** » Sun Aug 14, 2005 8:12 am

I have two Bc/BS policy, one State one Fed'l. Between the two they paid 100% of the DME allowable, the sleep tests, the Dr., the EEG, and everything else related. EXCEPT, BCBS only pays for a new mask every 3 months. I knew I couldn't tolerate the Breeze that long and ordered a Swift 5 weeks into treatment. It arrived the next day. That was $118 out of pocket. I've also bought "memory foam" pillows, both "total" and "partial, both "Neck" and regular for about a total of $75, and a little star-shaped "cushie" pillow for about $5 that I thought might work well as a "PapPillow", and it did. Just didn't give much for the rest of my head. Total "memory foam, regular pillow was too high. Imitation one didn't have the right density. Partial one with down outside and "memory foam" center also didn't feel right, but my husband loves it. Mother gave me an old REAL TemperPedic Neck pillow and it is "Just Right". I use the Big Pillow, regular size for under my knees for my back and it is Just Right for that.

8 months have passed and I still haven't ordered another mask. Can't make up my mind what I want. The Comfort Curve was intriguing but I've heard so much about you can't side sleep with it, that I don't think I want to put that much out of pocket and wait for insurance and then hate it.

Sleepless on LI · Post by **Sleepless on LI** » Sun Aug 14, 2005 8:24 am

Janelle,

The REAL Tempur Pedic pillow is what I use now every night. It's called the Comfort Pillow. It's worth the money, I think, although it would be nice if it were cheaper.

About your new interface, I know you're a side sleeper so I won't mention the one I was going to (the Nasal Aire II). The two tubes literally get affixed to the headgear over both ears. That put that one out of the running for me.

Did you ever try RG's Aura? Some people love it, but it looks too similar to the Breeze to me as fas as bulky headgear. I don't know. You have me thinking, what would I try next??? What are you leaning towards?

JPZ · Post by **JPZ** » Sun Aug 14, 2005 9:09 am

DME charged $2750 (including my $425 co-pay) for REMstar Pro 2 CPAP with humidifier + Swift mask.

CandyADiva · Post by **CandyADiva** » Sun Aug 14, 2005 11:06 am

Well I didn't pay for anything out of pocket. my first sleep study was 3,000 and my second sleep study with titration was 3,000 and I had no copay for those and then my insurance use Apria (DME) and they paid for the machine and all the supplies and every 6 months I get everything new again I had no copay for that either . My machine I have is a Remstar Plus C-Flex with a Remstar Humifidier I love it everything work out great.

christinequilts · Post by **christinequilts** » Sun Aug 14, 2005 5:15 pm

I've been lucky- my first month trial on BiPAP ST was with a free loaner from my sleep lab- my insurance was only billed for the mask & such. Medicare and my secondary insurance has paid every penny and what they don't pay my DME writes off including a heated humidifier that Medicare wanted to reject because it was delivered a couple days before my rental BiPAP ST- DME wrote off the $250 when they could have made me pay. I did purchase a slightly used (less then 20 hours) backup BiPAP ST early on which has come in handy from time to time and a couple masks on Ebay when I first started treatment 20 months ago. I also bought the Encore software which was only $99 since I don't need a card reader with my Synchrony. Other then that my only out of pocket expenses have been for fabric to make a hose cover, occasional new pillow to try, and teflon plumber tape (which should be in every xPAPers nightstand).