My machine is a rental?

[JaceS]

I just read the fine print on the contract of my new CPAP "Escape" and it indicates it is "rented".
All the other pieces-parts appear to be "purchased" by my insurance company (BC/BS) but the CPAP machine itself indicates it is a rental (which they pay for).

It all makes sense now; because the supplier slapped a communicator on the back of the CPAP and said if I am not in compliance the insurance company will yank the machine from me. Based on other's experience, will they ultimately convert this into a 'purchase which I own; or do they do this for a test period to make sure the patient actually uses their CPAP and once that is determined they buy it for me.

Since joining this discussion board I discovered the ResMed Escape is the bottom of the food chain; and I'm in discussions with my doctor to upgrade me one level (Elite) so I can monitor some data.

Anyone know about this rental vs own issue?
Many thanks

Jace

[Pugsy]

The rent to own is common and rental term will vary between insurance companies.
Medicare is 13 months...others vary from 30 days to 90 days to 6 months. At the end of the "rental" term you own it..and they don't give you a "better" machine...they let you keep the brick they originally dispensed.
Now is the time to get it swapped out if you ever want any data available to you.

The other equipment like mask, hose, humidifier are pretty much always a straight up one time purchase and can't be returned...and yanked away if someone fails compliance. There might be a few exceptions but not many...not Medicare.

Who is your insurance carrier and have you checked with them directly to find out exactly how they go about things???? Don't rely on what a DME might tell you. We have heard reports of all sorts of lies....from "rental" term to what is covered. It's your responsibility to get the information first hand from your insurance company.
Especially since you got the Escape...most likely your insurance company pays by HCPCS code and all the cpap/apap machines use E0601 HCPCS code.
That includes your brick Escape...they dispense it because it is cheaper to them and thus increases their profit margin. They might tell you that your insurance won't pay for anything else but I bet your insurance company pays by HCPCS code and not brand or model...and if that's the case the DME could dispense a full data machine if they would just do it.....they just don't make as much money on it.

[flyingwithoutwings]

I have BC/BS (Florida Blue) thru my employer. Rental is 3 months and then they purchase it if you're in compliance. The DME gave me a brick also, which I was unaware of (since I had zero knowledge of this new venture), until Archangel brought it to my attention and Pugsy advised me on what to do. I did call BCBS and they do pay by HCPCS code but it was an uphill battle with my local DME, they would not budge and I ended up returning their brick and buying my own machine. I hope you have better luck with your DME.

[Jeannh]

it was an uphill battle with my local DME, they would not budge and I ended up returning their brick and buying my own machine.

This is common. The DME makes the rental payments as pure profit - since they have your old machine to "rent" to someone else. I would call your insurance Co, though, and make sure they did not bill them for a "purchase" after the rental. That's fraud.

[flyingwithoutwings]

The DME makes the rental payments as pure profit - since they have your old machine to "rent" to someone else. I would call your insurance Co, though, and make sure they did not bill them for a "purchase" after the rental. That's fraud.

No,they didn't bill for a "purchase" but I did get stuck with paying the rent for the month of November even though I returned it on the 4th. And I'm sure they rented it to someone else and made double the rent money on it.

[Jeannh]

And I'm sure they rented it to someone else and made double the rent money on it. :(

This is what I've been told (and validated) about DMEs: If it's midnight and they tell you it's dark outside, go see for yourself.

[Janknitz]

Make sure you read this: http://maskarrayed.wordpress.com/2011/0 ... h-a-brick/

[JaceS]

Make sure you read this: http://maskarrayed.wordpress.com/2011/0 ... h-a-brick/

Before I read this article, I called my DME this morning with no awareness that they would try to derail me. The customer service person blew me off totally. She used every excuse that I just read in the article. I said, "Why are you being so resistant? I AM the customer!" I have had my brick only 6 weeks and the lack of data capability is troubling. I sent a note to my MD asking her to re-write the Rx for a the "Elite"; I will call BC/BS Florida next to make sure they are on-board, and then I'll physically go into my DME's store front an share my thoughts. It's hard for them to blow someone off when they are 300 lbs and 6'6 and in your face! Moreover no office likes to have a customer raising their voice in front of other customers. Wish me luck.

Thanks so much for the advice and suggestions. Shall I throw a goodbye party for "the brick"?

[AdamRRT]

There's no problem with them re-renting it. In fact, they COULD give you a used machine that wasn't billed the full 13mo from my understanding, as it's not considered "used" until it's been paid off once. That's just my understanding, but since my employer doesn't follow that practice, I can't be 100% positive. This is an issue I've been researching as well with the craziness of the recent Round 2 of Competitive Bidding. In fact, Medicare's wording doesn't require the DME to provide you with a new machine, nor any additional data capability. I know the DME I work for only puts out the upgraded data models when ordered by the physician, and that we do out of courtesy to keep the referral source happy. They could even charge you for the price difference in the upgrade, since they're under no obligation to provide you with the machine that gathers additional data. It's a common attitude on here that somehow maximizing profit is a bad thing, but it's how it works. Nobody goes into business to make less than optimal profit. You're free to get your machine on your own if you don't like the way your DME is operating. But you'll have no support to go with it. That's where the problem comes in.

[BlackSpinner]

There's no problem with them re-renting it. In fact, they COULD give you a used machine that wasn't billed the full 13mo from my understanding, as it's not considered "used" until it's been paid off once. That's just my understanding, but since my employer doesn't follow that practice, I can't be 100% positive. This is an issue I've been researching as well with the craziness of the recent Round 2 of Competitive Bidding. In fact, Medicare's wording doesn't require the DME to provide you with a new machine, nor any additional data capability. I know the DME I work for only puts out the upgraded data models when ordered by the physician, and that we do out of courtesy to keep the referral source happy. They could even charge you for the price difference in the upgrade, since they're under no obligation to provide you with the machine that gathers additional data. It's a common attitude on here that somehow maximizing profit is a bad thing, but it's how it works. Nobody goes into business to make less than optimal profit. You're free to get your machine on your own if you don't like the way your DME is operating. But you'll have no support to go with it. That's where the problem comes in.

What support? Please detail the support that almost nobody here has been provided with.

[JaceS]

With all your advice, the "exchange" from Escape to Elite went like a charm. There was push-back from the DME so I then called Florida BC/BS who said, "if your DME gives you any problems, you let us know and we personally will rattle their cage." I verified with the MD that she had written the Rx for the upgrade and she said the DME received it yesterday.

I called back the DME and lo and behold they couldn't have been nicer. Apparently they got a call from both FloridaBlue (BC/BS) and from my MD office and they were told they would not receive any more business from this major hospital if they didn't start treating the patients properly.

Worked like a charm.
Now I have my ResMed Elite and have to learn what all the data is that I'm suppose to look for.

Thanks to all, and to all a good night.

Jace

[Janknitz]

CONGRATULATIONS!

But I do want to correct one thing you said:

"I said, "Why are you being so resistant? I AM the customer!"

The reason you had success shows precisely how wrong this statement is. As far as the DME is concerned, their customer's are BC/BS and your doctor. They get repeat business from them. You are nothing to them, they don't care if they lose your business. There are thousands more where you came from who aren't smart enough to know a brick is a brick. They'd just as soon see you walk into the next DME and lose your business entirely, than do business with you for a loss of the $30 difference between a brick and the Elite. They don't even care that they are throwing away your repeat business for supplies FOR THE REST OF YOUR LIFE. It's screwy but true.

You did absolutely the right thing by engaging your doctor and insurer in the process because THEY have the clout you do not. Not even 6'3" of you

But it all came out well in the end, thanks to your persistence and luck in having good advocacy from your doctor and insurer.

[flyingwithoutwings]

Good deal! When I called BCBS they said 'If that's what the DME said, then that's what it is. What? And when I asked my doctor for an Rx she called the DME Rep instead and let them convince her that all insurance would approve is a compliance brick.

Congratulations to you!

[JaceS]

6'3? That's short... I'm 6'6, Jankenitz.

I happen to mention to the entire office staff at the DME's in a LOUD voice: "my doctor and the entire pulmonary department at the Cleveland Clinic will be asked to refer future patients to a different DME.." I think that got their attention too.

And the funny part... now that I have the Elite, I have absolutely no clue how to interpret the data. Guess I have to start reading many of the links to figure out what all the numbers mean. I'm really looking for AHI but I guess the rest of the data will be useful too, no?

[Pugsy]

Start with the AHI and leak understanding and then work your way through the rest of it if it interests you. AHI event category breakdown and total AHI and leak evaluation is mainly all I ever bother to look at anyway. Your leak number to avoid is 24 L/min...All explained in my little tutorial but it's sort of a novel so read at your own pace.
I have the basics in the tutorial in layman's terms
understanding your data viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html

There's also the official ResScan version
http://www.apneaboard.com/ResScan_Inter ... -Guide.pdf

http://montfordhouse.com/cpap/resscan_tutorial/ Tutorial for ResScan with additional examples. Send me a private message if you want to try ResScan. Windows only though...no Mac version of it like there is SleepyHead.