Go with the Affiliated Supplier or Shop Around?

[moonslice]

Just finished the titration and they have me an appointment for a class to get to know my CPAP and it's - surprise- with Methodist. I used a Methodist facility. I'm fine with that as it's close by and covered by my insurance. However, there are several other supplies covered under my insurance.

This place would be handy because it's connected with my doctor's office and close to my home. But should I shop around instead of just going to the one they set me up with? The prices would be the same since I have insurance. I guess the question is brands carried.

[lindalrc]

My vote would be to give them a good try. BUT treat it like any other new medical office or any store you might go to. Is it clean? Do they listen? Do they interact well with the MD? What are their policies on trying masks? (This is important because the masks are pricy and it can take 3 to 10 tries to find one that works for you.) The fact that they are offering a class is great!!! Many places just hand you a machine and say "Here is the on button. Goodbye."

You are very fortunate that you have other choices.

ALSO, read the experiences on getting started that are on this site. As per the novel Dune, "Beginnings are delicate things."
Lindalrc

[chunkyfrog]

Is your insurance an HMO? If so, you may not have many options.
Call your insurance, and find out who is in their network.

[Okie bipap]

I used the DME that was associated with the sleep clinic where I had my testing done. They are all owned by a local hospital. I was very happy with them, but they recently lost their Medicare contract.

[moonslice]

"Beginnings are delicate things."
Lindalrc

Nice quote!

As for the mask, I guess you have to buy that? It's not part of the rental, then. It makes sense that it would be a supply, not a durable medical. My coverage for durable medical for rental or buying after the three months is 90 percent. Not sure if I get any coverage for supplies though. My class is on the 22nd, and that's when I get the machine too. So, I guess I have some time to read up on this stuff. It's this whole new confusing world with terminology I don't get yet.

Chunky frog, I have several choices, not HMO. My insurer emailed me a list of around a dozen places I could use for this.

[Okie bipap]

Normally, if your insurance covers the machine, they will also cover your supplies. Most insurance companies allow a new mask either every three or six months. Some allow replacement cushions in between new masks. You will need to check with your insurance company to see what they cover for supplies.

[mummmz]

Post by moonslice on Tue Jul 12, 2016 6:28 am
Just finished the titration and they have me an appointment for a class to get to know my CPAP and it's - surprise- with Methodist. I used a Methodist facility. I'm fine with that as it's close by and covered by my insurance. However, there are several other supplies covered under my insurance.

This place would be handy because it's connected with my doctor's office and close to my home. But should I shop around instead of just going to the one they set me up with? The prices would be the same since I have insurance. I guess the question is brands carried.

Glad to hear you got through the titration. It's nice they offer a class. I would just go with the Methodist one if I were you. You already stated the positive things about it (that's what I highlighted above). They should be able to supply what you used in the titration. Do you know what the name of the mask you liked?

Have you called your insurance yourself or are you getting your information from the DME? Get a list of questions together and call the insurance to get your answers. Also get a copy of your prescription to have in your files and a copy of your sleep study and titration.

[Guest]

Honestly I am always leary of any DME connected to a doc or sleep center bc they normally don't offer you the choices of equipment and supplies but direct you to what will maximize their profits. Nor do they offer patient respect or courtesy. If the doc gives you trouble about sending your script anywhere else that is another clue you are being taken for a ride. It's all about getting your money, nothing else.

[chunkyfrog]

My first DME is not approved by Medicare.
I was told it is because they are also a sleep lab.
Medicare has a line that may not be crossed, and that is it.

[SewTired]

Decide ahead of time which machine you want and make sure it is data capable (meaning it provides the wave data, not just compliance). Call them and find out if you can get the machine that you want. If not, you are better off just getting one from an online supplier.

[Okie bipap]

I would stay with them at least for the time being. The DME that I first used was connected to where I had my sleep studies done. In fact, one of their offices is in the same building. They carried Resmed and Phillips Responics machines and a full line of masks. I would still be with them if I could, but thy lost their Medicare contract this month. Now, I have to start looking for a new DME.

[ChicagoGranny]

it's with Methodist

If you are choosing, go with Methodist.

If someone else is choosing for you, go with Presbyterian.

[klm49]

My Sleep Dr. has a DME out of his office. I am on Medicare (PPO) and he told me it was against Medicare rules for him to also be my supplier (DME).