Am I getting robbed?

[Crazy Eddie]

The sleep clinic I went to told me that I'd be renting my device for 3 months and then I'd be buying it. I got a bill for $800 and figured that was it.

They're still charging me rent!

So I went to my insurance website and checked out the codes in the EOB's. They apparently only sold me the humidifier part???

Does that make any sense to anyone else?

[Bill44133]

The humidifier is considered a separate piece of equipment on most machines. With my insurance I had to pay rent for 12 months it was like $23 per month.
The insurance company sent me a letter saying that since I was 100% compliant they bought the machine for me and I don't have to pay rent any more.
I ended up paying 4 months rent on the machine. My insurance company paid for the humidifier less my deductible.

Good Luck!

[zoocrewphoto]

I suspect the $800 is for the 3 months rental of the machine, the mask, the headgear, the hose, the humidifier, and the tank. The only thing that is a rental is the machine. Everything else is a straight purchase. And yes, they charge a high amount, so it looks completely unreasonable. If you don't have an invoice, I would go to them and ask for an invoice that itemizes everything to make sure that is all.

[chunkyfrog]

Yes, you are getting robbed, but it is just the way things are for all of us.
The idea is to keep the $ damage down, but still get the best therapy.
As much as my machine cost, our softside waterbed cost more--
and my hearing aid was way more! It's all perspective.

[Goofproof]

If they demand the money from you, (bill you) that's being robbed. If you pay the bill that's a donation. (may be tax deductable).

Find out what you are paying for and what you will be paying far down the road. ( This should have been done before you jump in, but we never do.)

Then decide if you can live with it, or go another direction and buy online.

[StuUnderPressure]

The EOB will tell you exactly what was purchased, what the insurance paid, & what you are responsible for.

I would not pay any more than what the EOB says you are responsible for.
If you have already paid more than that, ask for a refund.

Don't forget to consider the rental payments which may each be on a separate EOB.

[Janknitz]

The sleep clinic I went to told me that I'd be renting my device for 3 months and then I'd be buying it. I got a bill for $800 and figured that was it.

People can only take advantage of you if you let them. You did not do your homework first. You should have called your insurer BEFORE you dealt with the DME to understand EXACTLY what your coverage is and how it works. You should never rely on what the sleep clinic says (they deal with multiple insurers every day and can't possibly know the details of every plan) and NEVER, NEVER, NEVER, NEVER, EVER rely on what a DME tells you about coverage (sometimes they make mistakes, often they LIE).

You did not even look at an itemized bill before paying the $800 to see what exactly $800 is for???

In general, most insurers require a rental period that can be anywhere from 30 days to 13 months. During the rental period you will pay the deductible (including paying it AGAIN when January 1 rolls around), plus your co-pay based on your plan and your insurer's authorized price for the blower only. Some insurers will give you the option to purchase or continue renting--you need to know which is the most advantageous to YOUR pocketbook, not the DME's. The humidifier, humidifier chamber, hose, mask and filters are almost always outright purchases--and those plus your co-pay for the first month of the machine are probably where your $800 went.

So you need to get on the telephone and talk to your insurer (nobody else!) and find out exactly how it works with YOUR insurance company and plan. Then if the documentation provided by the DME does not follow the insurer's policies, you can deal with that. But you have to be a wary consumer, you cannot rely on these other folks (DME and sleep center) to tell you what you need to know.

It may be that you are not getting "robbed" at all, or perhaps you are, but unless and until you understand how your insurance works you'll never know.

It's a little late, but take a look at my blog post "What you need to know BEFORE you meet your DME" in my signature below.

[Crazy Eddie]

To tell the truth, yeah I didn't check shit out at all. I just took what they gave because it was working.

I didn't actually pay any of that $800, the sleep study and a scary mole took up my deductible, but I switched to HSA this year and I just found out that I'm going to be dipping into the account more than I had expected. I think it still works out to have the HSA...but I really wish the big expense had been last year when my deductible was all paid up.

Thinking now I might just get something from an online shop. Found one that's "in-network" and they sell a complete CPAP that looks decent for only twice what the humidifier alone was billed for. If It's a rental I can just give it back, right?

It's also a second annoyance because I just battled Comcast over who owned my modem, which they sold me and then decided they were going to charge rent for...two years after, claiming "We don't sell modems"...so this whole rent/purchase thing has me extra butt sensitive atm. Luckly I had receipts all the way back that far on the modem thing, but this shock has me annoyed.

It is a great deal my own fault though. I should have been watching the codes and checking things out more.

[Janknitz]

Don't get taken again if you buy your own machine!

1. Make sure whatever machine you get has full efficacy data. The machine info on my blog is a little outdated, but in general you do not want anything with Escape in the name and avoid the Philips Respironics System One Plus (but the Philips Respironics Sytem One CPAP with C-flex plus is OK--go figure).

2. You can avoid spending a lot of money by simply replacing the blower unit of the machine you already have and using the existing humidifier on the new machine. Of course that requires you to get the same brand and series that you already have.

I think we all come into this pretty naïve, thinking we shouldn't have to go all consumer ninja for medical equipment. We mistakenly believe that our sleep clinic, physician, and DME are all interested in our health as a priority, and that they would never take advantage of us. Stinks when we find out that's not the case.

[StuUnderPressure]

I think we all come into this pretty naïve, thinking we shouldn't have to go all consumer ninja for medical equipment. We mistakenly believe that our sleep clinic, physician, and DME are all interested in our health as a priority, and that they would never take advantage of us. Stinks when we find out that's not the case.

So, so true!!!!!

Excellent summation.

[flyingwithoutwings]

I too almost got stuck with a brick because, according to the DME, I only needed to show compliance. I'm so grateful for this forum because I've learned so much. But, I wonder how may people with OSA are faithfully using a brick, not knowing whether or not it's really working for them because they don't know any better. I only wish I had found this forum prior to going to the DME for my equipment. Would've spared me a lot of frustration and miserable nights.

[Redonthehead]

I'm right in the middle of this. As above, it seems I am renting the machine for 3 months, after which if I am compliant, then $$ paid for rental will be applied to the purchase. Everything else is a straight purchase - at stupid high prices. I had suspected that would be the case but I tried to buck the system of insurance "in-network" vs online and it was going to be a problem. Once I am settled in and running I will be buying my supplies direct.

[jencat824]

I think we all come into this pretty naïve, thinking we shouldn't have to go all consumer ninja for medical equipment. We mistakenly believe that our sleep clinic, physician, and DME are all interested in our health as a priority, and that they would never take advantage of us. Stinks when we find out that's not the case.

So, so true!!!!!

Excellent summation.

+1 !

Jen

[cpapdenmark]

I feel sorry for you guys, that you haft to buy or lease it, when people in Denmark are getting it for free (ok we pay through taxes) ... i have a Resmed S9 autoset with humidifier and with two masks, the one is the Mirage Softgel and the other is a Swift FX...i just asked if i could get these two and i got them....free of charge of cause and get two new ones every 6months and a new machine every 3years or if it get broken before that. Nice i dont have to worry about money when its about health here in Denmark. This is not a "look at my great country" statement, just wished you had the same where you live.

[rkuntz]

I feel sorry for you guys, that you haft to buy or lease it, when people in Denmark are getting it for free (ok we pay through taxes) ... i have a Resmed S9 autoset with humidifier and with two masks, the one is the Mirage Softgel and the other is a Swift FX...i just asked if i could get these two and i got them....free of charge of cause and get two new ones every 6months and a new machine every 3years or if it get broken before that. Nice i dont have to worry about money when its about health here in Denmark. This is not a "look at my great country" statement, just wished you had the same where you live.

Won't happen here:
1) Cultural reasons - It's against the wishes of a majority of the population.
2) Demographic reasons - The US a nation with a large and heterogeneous population -
2.1) All the nations with nominally better WHO health stats are all nations with smaller populations and almost all of these have more homogenous populations as well.
2.2) The US has better WHO health stats than any other nation with a large population heterogeneous or not.
3) Political reasons - Advocates of revolutionary changes to Health Care cheated when forcing through their agenda and it's looking like they got caught.

The reality is that the governing structure of the large heterogeneous population that is the US, simply isn't efficient enough to make it work and make it work well. A secondary reality is that many of the preexisting problems with our system are themselves the product of inefficient government. actions.