Question for those of you who have to pay a Co-Pay.

[TalonNYC]

I have a PPO, and I pay 10% for all DME in-network, or 30% out of network - after my deductible.

I've already gone past the deductible due to a medical hiccup (bronchitis that landed me in the ER) earlier this year. Thankfully it was the ER just because it was Friday of a 3-day weekend, and my doc was not available for 72 hours =(

That means I got full benefits for the CPAP and the Sleep Study, et. al.

If I buy from our hosts, I pay 30%, which isn't bad, but for routine stuff I go through Apria, who is the only "in-network" DME provider in my area for my insurance.

I use an FSA to pay the out-of-pocket, though those were severely cut this year, back to their pre-2008 levels. The dentist takes most of that $$ each year LOL

[jmcanzo]

If you are paying medical costs out of pocket for DME and supplies, you really need to take advantage of a Flexible Spending Account if one is available to you. That way you use before tax dollars instead of after tax dollars.

The only downsides are any money not spent at the end of the year, or the grace period after, goes to the plan administrator, and once you start the contributions at the beginning of the year you cannot stop them except by losing your job.

The upsides are: you don't pay income tax on the money that goes into the FSA; the entire amount of the annual commitment is available at the start of the year; and if you lose your job during the year and have been reimbursed more than you have contributed you don't have to pay it back.

If you have a reasonably predictable medical outlay during the year, and an FSA plan is available to you, you have no good excuse to not take advantage of it. If you are mortally opposed to the idea you may lose some money at the end of the year, then set up your FSA to cover something like 80% to 90% of the expected expenses. Paying 80% of your medical costs with pre-tax dollars is a lot smarter than paying 100% with post-tax dollars.

Definitely the way to go! Also a lot of people do not realize that they can use the full amount on day 1 and loose/quit their job they do not have to pay it back. My FSA is a VISA Debit card, I even used my FSA to pay for the software and smartlink module. They accepted and approved it when I sent them the Rx and the form CPAP.COM sent when I ordered it.

[louspeachy]

My co pay will remain the same for the new insurance year, 20%. I really don't think it is a bad deal, considering the insurance we had when my husband was working didn't cover durable equip at all.

Louise

[leejgbt]

Any co-pay is not dependent on DME...it's part of your health ins policy. Mine is approximately 15-20% for covered equipment/supplies.

However, there are some DMEs who waive the copay, accepting whatever the Ins covers as payment in full. And mine even ships Priority 3-day! (I live close enough they usually arrive the second day.) That's the best deal I've found.

This comment concerned me for two reasons. The first comment about a co-pay is not dependent on DME is not exactly the case. DME can be carved out and have no co-pay or a different co-pay or even be subject to conditions that say if you do not use a specific supplier there is no coverage. So, this comment is way to general to be accurate. Second, DME's who waive the co-pay, without first establishing a financial hardship exists for the patient, are violating insurance regulations and could (and should) be subject to prosecution.

Sorry to be so harsh as I usually enjoy your point of view but these comments just needed a response.