owning machines?

[energy quest]

Does anyone own their own machine and the software to read the card inside the machine? My husband thinks the DME who supplies my CPAP is ripping off my insurance and Medicare (and they probably are). I pay $16.50 every 2 months, which is not bad, I guess. But the DME supplier bills Medicare and my insurance an exhorbitant price.

[chunkyfrog]

Could you register, filling in your equipment (text, please), so we can tell you accurately?
Some upper level machines are well worth the co-pay, many others are not.
I had my first machine purchased by insurance less 10% co-pay; the next two were out of pocket ONLINE
(where the prices are much better)

[dpmurphy]

I wwnt through the samw thing, but it was actually a 10 month rent-to-own deal. So after 10 payments of $16, now I own it. When you look at what they charge for these machines, $160 isnt so bad.

[cosmo]

.

[squid13]

If you got your machine through Medicare then after 13 months you will own the machine. Medicare uses the 13 months rent to own.

[Janknitz]

DME bills are works of pure fiction. Don't worry about the price on the bill, that's not how much anyone pays unless you're a poor sucker who walks off the street with NO insurance.

Each insurer determines an allowable amount and that is the price, no matter what the DME wants to charge. Medicare pays 80% of the amount Medicare determines is allowed in your state, you (and/or your supplemental policy) are responsible for the remaining 20%. Medicare requires a 13 month "capped rental," after that you own the machine.

Other insurers vary. They may pay 80% up to 100% of the allowable amount. Some insurers buy the machine outright, others require a brief rental period before they buy it, and still others require you to do a rental just like Medicare for a certain number of months.

The practice of requiring you to pay the difference between the insurance allowable and the amount the DME charges (which can be a substantial difference) is known as balance billing, and it's usually NOT permitted either by the contract the insurer has with the DME (assuming that's a preferred provider under your insurance) or by state law. Sometimes people do have to pay it--for example, a non-participating Medicare DME provider may charge higher than the insurers allowable fee, BUT only after issuing a written notice called an "advance beneficiary notice". Since most DME's do accept Medicare and other insurers allowable fee, it's always worth it to shop around on those rare occasions when a DME legally can practice balance billing.

[cosmo]

Kaiser's prices are on par with cpap.com prices. I was surprised to see that on the invoice.

[chunkyfrog]

Our first DME got a couple hundred more for my machine from insurance than our host would have charged outright.
We were stuck with a $415 upcharge for hubby's Autoset because the doc wouldn't help and no DME's in network would help either.
BCBSNE's allowable for most masks are about double the online price. Cushions and pillows, too.
Headgear more like a 40% mark-up. Filters were a sixth at cpap.com than insurance allowed for the SAME filter.
I got a letter from insurance, wondering why no pap-claims. I really should let them know why.

[MyIdaho]

Our first DME got a couple hundred more for my machine from insurance than our host would have charged outright.
We were stuck with a $415 upcharge for hubby's Autoset because the doc wouldn't help and no DME's in network would help either.
BCBSNE's allowable for most masks are about double the online price. Cushions and pillows, too.
Headgear more like a 40% mark-up. Filters were a sixth at cpap.com than insurance allowed for the SAME filter.
I got a letter from insurance, wondering why no pap-claims. I really should let them know why.

My group insurance is through BC of Idaho and their allowable prices are on-par with prices at cpap.com and other online sources for supplies. I buy my supplies through my DME because it is within network and matches or very similar to the better priced on-line retailers...

[StuUnderPressure]

When I bought my ResMed S9 AutoSet in December 2011, the BC/BS PPO "allowable" prices for the ENTIRE system (APAP, Humidifier, Mask, & accessories) was about $50 +/- LESS than cpap.com.

[Java]

Kaiser's prices are on par with cpap.com prices. I was surprised to see that on the invoice.

Wow! Not in Southern California. I have Kaiser with Apria as the DME and the paperwork said my machine was $899! It's $595 on cpap.com. Thank goodness I have no co-pay and 100% coverage.

[jtmarten]

After a DME told me their bill to my ins co for the first month was $850 (of which I pay 20%), I bought a machine on craigslist. A brick, prior to getting good advice here about getting a machine with data logging. Sold it for what I paid (netting a free comfortgel nasal mask and hose), and bought an S9 Auto for $799 brand new online.
I guess I'm one of the lucky - I've never dealt with a DME except over the phone.