APAP / Hybrid mask coverage

billionzz · Post by **billionzz** » Thu Jul 27, 2006 11:35 am

I have a couple of questions about coverage that I was hoping someone could help me with.

I got the doctor to write a scrip for the an APAP machine but my DME is telling me that it will cost them $370 more than a CPAP machine and that I would have to pay the difference in the first 6 months, is this a good deal?

Also the DME doesn't carry the Hybrid mask but they said that they would get it for me but I would have to pay the difference on it if it was to much.

I have full medicare insurance and a decent Bluecross / Blueshield plan.

Does anyone have any thoughts on this?

Thanks for your help,
Bill

Linda3032 · Post by **Linda3032** » Thu Jul 27, 2006 12:14 pm

Alot of DMEs pull this cr*p. Find another one.

mousetater · Post by **mousetater** » Thu Jul 27, 2006 12:30 pm

With Medicare coverage, I would start here:
http://www.cpapforseniors.com/
owned by the same company that sponsors this board.

krousseau · Post by **krousseau** » Thu Jul 27, 2006 12:35 pm

I have full Medicare & FEPBlue Federal Employee Program-Standard option. When I started CPAP I did not have Medicare. I had a 10% co-pay of the amount that the Blues would pay if I used an in network provider and was not responsible for any difference since the DME was in network. Had a CPAP and switched to APAP. There was NO DIFFERENCE in the cost of the APAP for me. If I had waited until Medicare took affect and used the same provider I would have not had any co pays (once the deductible for both Medicare & the Blues was paid.
Be careful-Check with your insurance. I've had 4-5 different insurers over the years and have never had a problem getting them to tell me what I am responsible for (or not). Had an 8 hr surgery one time and the anesthesiologist must have wanted a new Mercedes as after the insurance paid their paltry sum his office billed me for the rest. The insurance company even took care of the letter to him explaining that he had contracted to be a provider for the amount they would pay.

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communilink · Post by **communilink** » Thu Jul 27, 2006 2:50 pm

This is more common that one would hope. The insurance company pays a set amount to the DME regardless of what machine and mask they provide. It is in THEIR best interest, NOT YOURS to give you the least expensive equipment they can get away with. If your insurance is like mine, and you have 100% coverage for DME, then they CAN'T charge you the difference. My insurance company contacted the DME, and told them to provide the equipment that was written on the perscription or risk losing their contract with the Insurarnce company. The DME then told me to go somewhere else, as they had the right to refuse service since they would be losing money to work with me.