Question for S9 owners

[jamboiga]

I am brand new to this forum, but was diagnosed with severe OSA in 2002 and on CPAP since then. I just recently got an S9 Auto after 8 years with an S6 Lightweight. My question is this: The DME that my insurance co. requires me to use sent the insurance co. a bill for the S9 machine and the humidifier. About a month later, they submitted a bill for something I didn't understand. When I called the insurance co., they said the second bill was for a slim line tube and a disposable filter. I told the insurance co. that I thought the machine came with the slim line and 1 disposable filter and that the DME was charging twice for the tubing and filter. Insurance co. said maybe so, but they paid it anyhow because they said it was standard procedure to have to pay for tubing and filter, but I could call the DME and ask them about it. In other words, they didn't care, just paid. Since I have a 15% co-pay on CPAP equipment, I thought I would call the DME and ask them about it, but first I wanted to find out the experiences of S9 buyers on this forum. Did your DME bill you for a slim line tube and a filter separate from the machine purchase?? I do know that when I went into the DME's local office to get a new CPAP, they did not even know what an S9 was, and it took a lot of pressure and arguing on my part to finally get them to order the machine. When it came, the technician opened up the box when I got to the office, and he was learning about the machine the same time as I was. The filter was already installed in the machine and the tubing was packed in the ResMed box with the rest of the stuff. So can anyone tell me if the slim line and filter comes with the machine purchase or is supposed to be charged separately??

[jdm2857]

I believe that every machine comes with a hose and filters. My S8 certainly did. I do understand that in the US, the S9 comes with only the SlimLine hose, and not with the heated ClimateLine hose. Elsewhere this is different.

The DMEs are another story. They bill for anything and everything they think they can get away with. For masks, some bill for the mask frame, the headgear, and the cushion separately, because they can bill more that way. And then, sometimes they steal the extra cushions or pillows (the sizes other than the one they think you need) from the mask package and sell them to someone else.

[DreamOn]

Welcome, jamboiga. I know that it seems odd because the SlimLine tubing and filter do come packed with the machine, but it is standard practice for the DME to bill insurance for each item separately. Here are the insurance billing codes:

CPAP or APAP machine: E0601
Humidifier (heated): E0562
Tubing: A7037
Filter (disposable type): A7038

They usually bill separately for headgear and mask too, even though they're packaged together.

You got a great machine! I hope that your therapy goes well.

[sleepnationtv]

Yes i work at a DME and that is how it works, the insurance requires the DME to bill in parts to make it easier for them to process replacement parts. It does come with a filter and tubing but the machine price is billed lower to make up for that. It is how the insurances prefer it.
http://www.sleepnation.tv

[jamboiga]

Thanks to all for your help on this. I love this forum-- a lot of great people offering each other help, support and advice!!!

[PetrusKy]

Yes i work at a DME and that is how it works, the insurance requires the DME to bill in parts to make it easier for them to process replacement parts. It does come with a filter and tubing but the machine price is billed lower to make up for that. It is how the insurances prefer it.

Somehow I doubt the DME will actually bill the machine's price lower.

I also find it ironic that the insurance company sets up a system that makes it easier for the DME to rip them/us off. Kind of like the fox guarding the hen house.

[jdm2857]

FYI: sleepnationtv is run by a DME in Utah.

[Gia]

Actually what the insurance companies usually do is set the *fee schedule* lower for the Code E0601 to include only the machine itself.

Yes i work at a DME and that is how it works, the insurance requires the DME to bill in parts to make it easier for them to process replacement parts. It does come with a filter and tubing but the machine price is billed lower to make up for that. It is how the insurances prefer it.

Somehow I doubt the DME will actually bill the machine's price lower.

I also find it ironic that the insurance company sets up a system that makes it easier for the DME to rip them/us off. Kind of like the fox guarding the hen house.