Insurance requires 2-month compliance rental

[Snuff-L-Reddy]

My wife had to start using a CPAP-----The good news is our new DME brought out 2 machines for her to choose, a Resmed S9-Autoset or RemStar Auto DS560TS with heated tube, they said they only provide Auto machines. We chose the RemStar. The problem is our insurance company requires a 2-month compliance rental before purchase. We were not able to get an appt. to get the machine until Nov. 1st which means that will put us into a new deductable/out of pocket period by one day on Jan 1st. As our out of pocket costs has been satisfied for this year this really sucks. Also the machine is below the cost of our policies outright purchase for durable medical equipment. I ask the insurance company if they would allow the compliance check on Dec.31st and they said no. Any suggestions on how one might circumvent this problem ?

[ughwhatname]

I've got the same problem, but mine is a 90 day rental and I got my machine on October 11. I'll hit 30 day compliance tomorrow with 100% compliance, but the insurance company insists on a 90 day rental, which will put me at January 9, with a new deductible. Bah!

My wife had to start using a CPAP-----The good news is our new DME brought out 2 machines for her to choose, a Resmed S9-Autoset or RemStar Auto DS560TS with heated tube, they said they only provide Auto machines. We chose the RemStar. The problem is our insurance company requires a 2-month compliance rental before purchase. We were not able to get an appt. to get the machine until Nov. 1st which means that will put us into a new deductable/out of pocket period by one day on Jan 1st. As our out of pocket costs has been satisfied for this year this really sucks. Also the machine is below the cost of our policies outright purchase for durable medical equipment. I ask the insurance company if they would allow the compliance check on Dec.31st and they said no. Any suggestions on how one might circumvent this problem ?

[Snuff-L-Reddy]

Our DME suggested coming in after 30 days to download and see if the insurance company would accept if in compliance for the period. Going to try that but don't have much hope.

[Slinky]

Check out the price of buying the same equipment from cpap.com and compare it to your out of pocket costs buying from your current DME provider. If it works out cheaper than trying to use your insurance (sounds like they won't by paying ANY of your costs ??) then before 30 days are up return your wife's equipment and buy from cpap.com online. All you need is a copy of her equipment order (prescription) which you should have in your possession anyway.

It sounds like yours is a pretty good provider if they only provide Autos so be sure to thank them and explain why you are returning her equipment and buying online. They "might" be able to cut you a deal to match cpap.com's price - but don't count on it. I don't think the locals have the profit margin to work w/that a large online provider like cpap.com does.

[chunkyfrog]

Lousy timing!
Most of us try to time the big tickets for the beginning of the year, if we can.
If you can find a used machine on CL or a travel machine online,or from stlmark,
it would be out of pocket anyway, and she could start treatment ASAP,
with insurance costs piled together for the new plan year.

[LSAT]

Maybe you can convince the insurance company to accept a 60 day compliance...that will take you to Dec. 30th.

[chunkyfrog]

Oddly, my insurance seems to be concerned that I am buying my supplies out of pocket. (they sent me a letter)
I still haven't reached my out of network deductible; and considering the DME prices,
I would have not met my in network, with way less stuff, and fewer choices.
Maybe I should give them a call. I already chewed the company out (in a public meeting)
for having unreadable ID cards printed with wipe-off ink.

[Snuff-L-Reddy]

Maybe you can convince the insurance company to accept a 60 day compliance...that will take you to Dec. 30th.

I believe our/most companys use Medicare guidelines----at least 4 hours a day for 21-days out of 30----so one should be able to be in compliance if they use their machine for 42-days out of 60 whether the month has ended or not. I am going to pursue this logic with our insurance.

[Janknitz]

If you can't work around the 60 day rental issue, perhaps you can get the insurance company to buy the humidifier, the mask, and the hose, so all you have to buy out of pocket is the blower--that may save you a lot of money.

[Bonnie]

I got my new machine in August with a nine month rental. My deductible was met so I will pay a small co-pay until January when I would have paid the full amount monthly for the remaining 4 months out of pocket. Now my company is changing insurance effective January. I've tried to get information (no cards, numbers, etc. assigned yet) from the new company, my company benefit's director and even Apria. Apria told me to contact my present insurance to see if I could buy it outright. No such luck, and they also said the new company will undoubtedly start the rental period all over! Either I work out a deal with Apria to buy it out right or I will return it and get it from Cpap.com. Apria was bugging me to send in my card because my insurance requested it. I called the insurance company and was told I was not required to do so. Three days ago I received a call from a nurse at the insurance company telling me I had to send it in, they need to see my compliance to continue the rental. Hello?, I only have a month remaining! If I don't have Apria read my card I can't continue to rent the machine. She also said someone gave me the wrong info and it is a 13 month rental!!! WHAT? I said no way was I going to send my card to Apria but would print out a compliance report and fax just that info to her along with the make and model #. She agreed and I did. Can't wait until the new year and see where this all goes. Oh happy days.....

[archangle]

Oddly, my insurance seems to be concerned that I am buying my supplies out of pocket. (they sent me a letter)I already chewed the company out (in a public meeting)for having unreadable ID cards printed with wipe-off ink.

I'd be very interested in what the letter said. Were they threatening or "concerned" that you weren't taking full advantage of their services or what? Is there any chance they're actually trying to help you by telling you that you can buy them though the insurance company and maybe save money?

I hate the fact that the only date on my card is "Date Valid," which is the first year I got my policy. Even though they send another card every year, the date on the card is 6 years old, and nowhere does it mention the current year.

[chunkyfrog]

They said they were 'concerned'; but they already know I've been ordering from cpap.com.
I turned in one claim, and their acknowledgement was that the money had been applied to my $800 deductible. Awfully hard to go over that out of network, needing only masks and supplies.
A lot faster in network ($400), especially paying approximately double for everything, and 6X for filters!
Unfortunately, the DME has a very limited inventory-(with no élan, they are of no use to me).

[Bons]

Life rots sometimes, doesn't it? I had to pay for my ASV in January of '11 - used up 2/3 of my FSA account in one fell swoop, but, on the other hand, met a good chunk of my $8500 out of pocket max.

Fortunately, my daughter's cpap became a purchase in December of that year, and we'd met our out of pocket max, so we didn't pay a penny. You win some, you lose some.