Insurance won't cover Cpap

[mags0615]

Hello, I am in need of a Cpap machine and my insurance won't cover anything unless I meet a $2500 deductible. Which is stupid because the machines don't cost that much. I need a good machine with humidifier and am fine with used, I have been checking Craigslist with not much luck. Can anyone guide me in any other direction?

Thanks

[BlackSpinner]

Secondwind.com is a good place people buy from. You will need a copy of your prescription. There are members here who also sell second hand - STLMark is one that I have bought from.

[Pugsy]

Check with forum member STLMark to see if he still has the PR S1 60 series Auto CPAP model 560 available.
memberlist.php?mode=viewprofile&u=49361
Just send him a private message and ask him...he did have a 560 for $400...that's everything and if you wanted the optional heated hose then another $75. I don't know if it has sold or not...brand new though.

If he doesn't have anything right now...send me a private message as I might have another lead.

Or if you can get your family doctor to write a RX....you can buy it online at cpap.com for new and secondwindcpap.com for gently used low hour machines.

You will want to zero in on either of these 2 machines..
The Respironics PR System One 60 series Auto cpap model 560....or the slightly older model 550 with no heated hose option.
Or the ResMed S9 AutoSet (avoid anything with Escape in the model name).
Cost wise you will find a better deal with the PR S1 machines and you aren't sacrificing quality. I have used both brands and it's a toss up...both have minor pros and cons but none are deal breakers or makes.
If you happen to like to go camping...get the PR S1 machine if you need to run off a battery. The Resmed will but requires an additional expense to convert from 24 volt to 12...around $80 or so if I remember right.

Don't go getting a S8 machine or one of the M series or older Respironics machines...they don't have the comprehensive data and getting what data they do collect requires special card readers.
Stick with the S9 AutoSet or the PR S1 560 machine because they use SD cards and even if your computer doesn't have a SD card slot...the adapters only run around $10 and are easy to find.

[spmccord]

I have worked in the health insurance world for 30 years now and it never ceases to amaze me people's ignorance of health insurance.

Your health insurance carrier WILL cover your CPAP. Your health plan has a deductible that must be satisfied before there can be payment.

Your health insurance carrier most likely has negotiated a discounted rate with area DME suppliers that would save you a lot of money. Plus, whatever amount ot the CPAP that goes towards your deductible will lessen the amount you will pay if you have an accident or illness.

[chunkyfrog]

Sorry, Mags has a deductible of $2500.
Sadly, some employers offer really cruddy insurance packages.
--insurance in NAME only

[bwexler]

What you say about insurance is generally true, but in my experience does not always work.
My insurance paid $175 towards eye glasses frames and an additional amount toward lenses but only at an in network provider.
I went to Costco and got my glasses and my wife's with no assist from insurance for less than mine from the in network provider after the insurance assist.
It is mandatory to do your homework and remember we are in November and a new deductible starts in about 6 weeks.

Also you have to consider the price quoted by an in network DME may differ from the price negotiated by the insurance company.
Apria quoted me a purchase price of $12,000 (yes thousand) for my new ASV DS960 machine. my 20% copayment would be $2400.
The sponsor of this forum offers the same machine for $3,020. So instead of the insurance company paying $2,400 and me a $600 copayment, the amounts get reversed. I am sure the insurance company would not complain about the over pricing or disclose the actual amount they would pay.

[Janknitz]

If you decide to buy the CPAP machine with insurance to use your deductible (what about your sleep study, didn't that count toward the deductible?), you may want to wait until January (assuming your sleep study didn't go toward the deductible) so that if you need anything ELSE during the year, part of your deductible will be taken care of already.

Not every insurance deductible resets by calendar year, so be sure to check with YOUR insurance company to find out when your deductible resets.

[JeffL]

Sorry, Mags has a deductible of $2500.
Sadly, some employers offer really cruddy insurance packages.
--insurance in NAME only

How do you know the insurance was part of an employee plan?
She might have bought the high deductible plan on her on?

[chunkyfrog]

I stand corrected. Group negotiation may not get either the best/worst deals.
It would not surprise me for insurance companies to make the most money on low-premium plans.
The "bottom line" is competitive, many policies sold; and most healthy people never discover how poor their coverage is.

[JeffL]

What you say about insurance is generally true, but in my experience does not always work.
My insurance paid $175 towards eye glasses frames and an additional amount toward lenses but only at an in network provider.
I went to Costco and got my glasses and my wife's with no assist from insurance for less than mine from the in network provider after the insurance assist.

I've bought glasses at Costco too, and since I prefer the lower cost frames, the damages aren't that bad. But it's not unusual for frames to be outrageously expensive. The frame business is a near monopoly controlled by the Italian firm Luxottica, and they charge ridiculous prices for a simple piece of plastic.

[johnthomasmacdonald]

I've bought from papman who posted here and it went very well.

[bwexler]

Yes but that plastic has a logo on it. That logo must be worth $100-200 alone.
The only plastic on my frames is the part that touches my ears, the rest I believe is titanium. I like the frames you can tie in a bow and they bounce back. On one occasion we actually ran over my wife's glasses with a Lincoln Towncar, took them into Walmart to straighten them out and she wore them another year.

[hueyville]

Wait till January and let machine apply to deductible. Then as you get that out of way spend the rest of the year doing sleep studies, blood work, MRI's and any other medical questions you have had lurking.

[CRMW]

Have you checked the online retailers? Our host CPAP.COM sells machines for less than my copay as my insurance only covers 80% of the cost of the machine.

[patrissimo]

If you decide to buy the CPAP machine with insurance to use your deductible (what about your sleep study, didn't that count toward the deductible?), you may want to wait until January (assuming your sleep study didn't go toward the deductible) so that if you need anything ELSE during the year, part of your deductible will be taken care of already.

This. With high deductible plans, you win by bunching your expenses into one year. If you haven't met your deductible for the year, right now is a terrible time to be getting care (assuming your plan resets in January). If you think you won't use much health care next year, then go ahead and look for a machine from another source (STL Mark is the best). But if you have other procedures that you or your family have been waiting for, and you can afford the deductible, starting doing them all in Jan and make 2014 your "year of healthcare". It's dumb, but that's the best way to play given the rules of the game. (Even more so given out-of-pocket maximums, if you are able to hit them).