Headed to the DME store tomorrow.

[SleepyQuilter]

Well now, the sleep doctor called and wanted the CPAP to begin right away, so he said he would fax the script right away. I did learn something on this forum already, so I asked him to write for APAP instead. He did this without complaint.
Tomorrow is the appointment to go in and try on masks and get my machine, and I have asked for an S8 Vantage. I was given the software to use with it, but I will have to go online and buy a card reader soon. I am excited as I am not getting much sleep at all now.
My question now is, how do I avoid any financial hyjinx here? The DME told me the other day that my insurance is good, which it is, and that I could have whatever machine I wanted because they basically get one price for the equipment and take the hit for the difference. My husband says he dealt with a different company, but after a year they began to charge him rent on his machine, saying our insurance company had paid all they would pay and the rest was his responsibility. I like this company I have chosen, but find it hard to believe that they are going to give me such a premium machine and not charge me later.
Have any of you any advice as to what to watch out for tomorrow?
I hope this therapy feels as good as it did in the sleep center.

[NightHawkeye]

Have any of you any advice as to what to watch out for tomorrow?

Congratulations, SleepyQuilter. Sounds like you've done well so far. I'd recommend making sure you are on a rent-to-own plan and know in advance exactly how much you are obligated for. It might take a few phone calls to your insurance and your DME to figure that out though.

From what I hear on this forum, the actual cost of the machine, even if it's an APAP, is small compared to the total cost charged by the DME. That's why they can give you an APAP without charging more. Even though they'd normally keep a few hundred more dollars by giving you a CPAP (since they're probably getting charging over $2000 anyway), they don't really get stung too badly when they have to give out an occasional APAP.

Regards,
Bill

[USERGUEST]

When you do get the equipment, make sure they send you the correct disposables. Allot of companies will bill for them and not send them. I actually work for a DME supply company and allot of patients that contact our company have had this problem. Besides that look over the contract and make sure there are no hidden fees associated with the rental. Allot of the times companies will discontinue their customer service once you have the machine. They will always bill but never help. If you have any other questions you can email me at jkennedy@orbitmedical.com and I would be happy to help if I can. And they can only bill for one set price because in the insurances eyes the BIPAP and CPAP machines are the same.

[NightHawkeye]

And they can only bill for one set price because in the insurances eyes the BIPAP and CPAP machines are the same.

Perhaps you meant to say that CPAP and APAP use the same billing code. The billing code fot BiPAP is different and allows DME's to collect considerably more.

Regards,
Bill

[johnnygoodman]

And they can only bill for one set price because in the insurances eyes the BIPAP and CPAP machines are the same.

This is incorrect. APAPs and CPAPs are the same in an insurance companies eyes. BiPAPs are NOT the same.

Johnny

[snoregirl]

While I am scheduled to pick up my machine this coming week, this is what one local DME that is approved by my insurance company says that they are going to charge me. Maybe it would be a good comparison for you.

APAP or CPAP (same contract price to my insurance company)
Remstar Auto w/CFlex Contract price to my insurance co $889.20
Heated humidifier that goes with the unit contract $ $239.70

This DME bills the insurance company in ten equal payments

I am responsible for a 25% copay of the contract price

Seems to come out to around $282 vs. a Cpap.com purchase with no insurance of $725 (my insurance co that they will not reimburse for purchase with no rental (or so they say when I call on the phone)

The $725 also includes the tubing (the tubing from the DME is below -- extra charge)

This (machine and humidifier) comes out to $28 a month. Rental paid comes off the purchase price when the Insurance decides to buy it I am told. Financial exposure to me is if for some reason compliance or otherwise the insurance co doesn't buy, then I am out the rental 25% ($28/month for a min of 3 months -- they say they won't buy until at least 3 months) If they won't buy, I am out at least $84 and have to buy for $725 from CPAP.com


Other quoted contract costs from my DME to my insurance company

FF mask Resmed ultra mirage $150.91 (I am a serious mouth breather)
Headgear $ 28.19
Tube $31.21

Total of this stuff $210.31 (I think this is one payment $53)
25% of contract cost

Hopefully this is helpful. I am sure all insurance companies and DME's are slightly different but this is what I am told by those I am dealing with. Hopefully the costs are correct I will read the fine print after reading the other responses here so I am not surprised.

[snoregirl]

What I forgot to say in my post a minute ago is that with a billing price to my insurance company of $1128.9 vs a cpcp.com cost of $725 for an APAP you can see that the DME is still making plenty of money ($434). They probably make at almost $200 more from a CPAP (if you look at the top of the line Remstar model with a Cpap.com cost of $540 (and the DME is still billing $1128.9.