Are the good reputable DME's?

[mzlaura1884]

Trying to start doing lots of my research now. I am pretty sure i know the mask i want already but not the machine. Anyway my insurance listed off some companies "in network" and i wanted to know if they are good DME's? I heard some are a nightmare to deal with.

I got Accusom?
Virtuox
Watermark Medical

Also there is no pictures of their products or pricing? What is up w/that? How do i know what machine i want if i can't look at price and see it in person or even online?

[chunkyfrog]

"In network" only means that your insurance has signed contracts with those vendors to set allowable prices for regularly scheduled equipment.
"out of network" means their asking price is the price you pay--out of pocket.--insurance may not even pitch in--or very little.
Anything bought 'off schedule' may be subject to an upcharge, no matter where you get it.
Reputable DME's? I have heard they exist; but I've yet to meet one!
You have to meet and greet with each one--after doing your research here.
Most of them wil guide you toward the cheapest products they have.
(They take no oath to "do no harm") --BEWARE!

[mzlaura1884]

Well i know "in network" i pay 20% and they pay 80% i think out of network is less.

This is what it says for my plan
Under the base benefit, 100% of eligible expenses, no deductible.


"IN NETWORK"
After the base benefit has been exhausted, 80% of eligible expenses after satisfying the deductible.



Benefits are provided for the replacement of a type of Durable Medical Equipment once every 3 plan years.



We will decide if the equipment should be purchased or rented. You must purchase or rent the Durable Medical Equipment from the vendor we identify.



At UnitedHealthcare’s discretion, replacements are covered for damage beyond repair with normal wear and tear, when repair costs exceed new purchase price, or when a change in the Covered Person’s medical condition occurs sooner than the 3 year timeframe. Repairs, including the replacement of essential accessories, such as hoses, tubes, mouth pieces, etc., for necessary DME are only covered when required to make the item/device serviceable and the estimated repair expense does not exceed the cost of purchasing or renting another item/device. Requests for repairs may be made at anytime and are not subject to the three year timeline for replacement.


There is a non preventative base benefit on this plan in the amount of $200 per person per plan year combined Network and Non-Network benefits. All paid dollars accumulate up to the maximum base benefit per person per plan year.


"OUT OF NETWORK"
Under the base benefit, 100% of eligible expenses, no deductible.



After the base benefit has been exhausted, 60% of eligible expenses after satisfying the deductible.



Notify Care Coordination

Please remember that for Benefits you must notify Care Coordination before obtaining any single item of Durable Medical Equipment that costs more than $1,000 (either purchase price or cumulative rental of a single item).



Benefits are provided for the replacement of a type of Durable Medical Equipment once every 3 plan years.



We will decide if the equipment should be purchased or rented. You must purchase or rent the Durable Medical Equipment from the vendor we identify.



At UnitedHealthcare’s discretion, replacements are covered for damage beyond repair with normal wear and tear, when repair costs exceed new purchase price, or when a change in the Covered Person’s medical condition occurs sooner than the 3 year timeframe. Repairs, including the replacement of essential accessories, such as hoses, tubes, mouth pieces, etc., for necessary DME are only covered when required to make the item/device serviceable and the estimated repair expense does not exceed the cost of purchasing or renting another item/device. Requests for repairs may be made at anytime and are not subject to the three year timeline for replacement.

[Pugsy]

To evaluate potential DMEs thoroughly one really needs a face to face meeting and maybe an initial phone call screening. It is going to be really hard to evaluate based on a website where only general information is given. They don't offer choices because you don't really get a choice in most cases. Remember we aren't supposed to understand all this stuff. At least that is most DMEs mindset.

[chunkyfrog]

Get your doctor to Rx a specific machine (with full EFFICACY DATA)
Get the contracted prices from YOUR INSURANCE (DME's can be evasive, and often untruthful) before you commit to getting anything from them.
Your co-pays may be more than the entire price online.

[mzlaura1884]

i CALLED A local DME that is in the same hospital building as my sleep doctor. They are not under contract with my insurance so i would be covered 60% under shared savings program but their prices are high she suggested on the phone the resmed s9 on the phone which i guess she says is $1500 yikes! And the mask i want is the Resmed Quattro FX with headgear for her. It's $185 on cpap.com but this DME said the same one through them is $285. She did however give me the # to Apria and they are contracted under United in which the united health care rep failed to tell me. They have a local office 10 min from me so that my doctor can fax them the rx or whatever and i can go in for a appointment and check it out. Their quoted prices seemed much better.

However the 1st place was willing to do payment plan but not Apria. Then again if i spend like $1500 at apria i only have to come up with $300 out of pocket. What i am thinking too is having them provide the machine and since it seems the mask is NOT included without their insane prices if i don't need a rx i will probably order my mask off cpap.com and i have a friend selling the exact same one used like 2x for $50. I think so far i am doing good in my research but man i am exhausted already too much information and things to find out.

[BlackSpinner]

She did however give me the # to Apria and they are contracted under United in which the united health care rep failed to tell me.

Go with what the rep says. never mind the DME's all they want is the sale. Most of them only know what end of the pen you sign your name with and not much else. They also lie.

[mzlaura1884]

So the s9 is a good machine i am assuming? And i know the mask i want i am advocating until i get it! So i am thinking resmed s9 with my quattro fx mask. Should i still go through Apria when the rep at the other place was clearly trying to sell me a higher end model (I know that's a good thing) she was being honest and not out for profit.
Usually they try to see u the cheap machines correct? Even though they get same amount from insurance company regardless. Gonna make sure my doctor writes out a scrip for this machine unless i need the flex but i don't know what that is. Do you need a rx for the mask?

[Pugsy]

You will need an RX on file for any online purchases for complete mask packages from places like cpap.com. Replacement parts don't require a RX though. Getting the RX on file is not difficult though.

Typically the headgear will last a lot longer than just the cushion and cushions can be bought separately without RX.
You don't have to buy masks from same DME that supplies the machine. You can buy masks through a DME even if you bought a machine online. Mask cushions will need replacement as time goes on. The silicone breaks down and doesn't seal as well.
How long they last varies between people. I use a nasal pillow type of mask and I get many months of use from one pillow but other people find that they need a new one each month and some people even more frequent than that.

Be sure to find out which model ResMed S9 machine that you are being quoted a price on. Don't assume that the $1500 machine is a full efficacy data machine. It could easily be the ResMed S9 Escape model which offers nothing but hours of use.
You might want to read up on which models offer what. Forum member Janknitz has composed a consolidated blog about which does what.
http://maskarrayed.wordpress.com/

[Sloop]

It has been my experience that once you have some number of years being a hose-head, you pretty much dictate to the DMEs what you want in terms of service. Same thing with the sleep docs -- when you are an old hand at this, they will LISTEN to you and pretty much prescribe whatever it is you want. And they'll do it in such a way to maximize your insurance benefits.

[archangle]

So the s9 is a good machine i am assuming?

"S9" means nothing. You need to specify the machine. For instance, S9 AutoSet is good. S9 Elite is OK, but less capable, S9 Escape or Escape Auto should be avoided.

Some DMEs are good, but they all tend to be focused on profit. The trick is often to make them compete. Ask them which machine you're going to get, then ask another one if they won't give you the machine you want.

Check my "useful links" link in my signature line below for some helpful hints on dealing with DMEs.

[KEQ5]

S9 Elite is the CPAP variant, fully data capable, very similar to the S9 Autoset which is the APAP variant.

Avoid the S9 Escape and S9 Escape Auto. Even though my Rx specifically said "S9 Autoset" they tried to give me an S9 Escape Auto. I refused to sign anything and they agreed to order the Autoset unit as they didn't have it in stock. Went back the following week, got a different representative who set me up with the S9 Autoset and she was *much* better then the previous week's rep. (She understood why I wanted the full data unit.)

S9 Elite / S9 Autoset work fine with the Sleepyhead software. I've been checking my data daily this first week and it's a great relief to be able to look at the charts, see that it's working, and to see *how* it works. Which makes me more comfortable when strapping a hose connected to a mysterious black box to my face. The box is no longer mysterious because I can see how it adjusts during the night in response to my apneas.

[leejgbt]

She did however give me the # to Apria and they are contracted under United in which the united health care rep failed to tell me.

Go with what the rep says. never mind the DME's all they want is the sale. Most of them only know what end of the pen you sign your name with and not much else. They also lie.

While I will admit that there are many sub par DME companies, I would say that you know very little about DME by using this statement. But, have hope! Medicare is in the process of eliminating 80% of all DME providers. This will eliminate over 100,000 jobs by some estimates. Perfect timing with the economy in such good shape. The remaining providers will most liely be national companies like Lincare and Apria (you like them, right?). Also good thing no one in rural areas need DME, I suppose all DME could be ordered on line........

[ladyhen]

Then again if i spend like $1500 at apria i only have to come up with $300 out of pocket.

Have you met your deductible and $200 "base"? Because it sounds to me from your coverage that you listed that you have to pay both of those out before they'll pay 80%...

(Just found out that with my own 80/20 plan, I have to first meet my $400 deductible - Thankful it's only $400!)

[mzlaura1884]

Then again if i spend like $1500 at apria i only have to come up with $300 out of pocket.

Have you met your deductible and $200 "base"? Because it sounds to me from your coverage that you listed that you have to pay both of those out before they'll pay 80%...

(Just found out that with my own 80/20 plan, I have to first meet my $400 deductible - Thankful it's only $400!)

I already used the $200 base and i had a $4,000 deductible i know YIKES and yes i have already met it.