I got my doctor to make out order for an auto cpap so when I no longer have insurance it would be bought already. Was told by my dme that my insurance doen't cover auto cpap. But they would let me pay out of pocket the extra 350 bucks and than will bill my insurance for the rest. I thought there wasn't that much differance between the 2?
My state insurance and cpap
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Yes, do some negotiating.
It took me 3 tries with the DME to get them to give me what was on my prescription. If you have the time and can stand to wait, keep calling them and bugging them. Tell different reps that you want what the doctor ordered.
For the most part the insurance company doesn't know the difference. Mine, considered APAP to be a Deluxe machine and they didn't cover it unless THEY decided you needed it. In reality, if the DME caves, the insurance company doesn't know or care.
The same billing code is used E0601 for CPAP is also used for APAP.
The key is one of two things. Letter of Medical necessity from Doc and maybe more discussion (if you want to bother your doc on this one) to get the insurance to cave. The Insurance co doc may overrule your doc (amazing as that may sound) or they may approve it. Some only approve it when CPAP fails. I don't like to recommend this route as you are taking something you don't really want from the DME and may have trouble getting coverage from another DME if the relationship sours.
Second way is hound the DME and hope they give what the prescription says. That is what I did. They called and said, we need to make an appointment for you to pick up your machine. I said, the one the doctor ordered. They said the Remstar Pro, I said I want the Remstar Auto my doc prescribed..... Then do it again, either they call you or you call them and initiate the conversation "I am supposed to get a Remstar Auto......)
Some people have had success all these ways
1) Doc supporting
2) Start CPAP and have problems
3) Hold out and hound the DME
Those are the basic choices as I see them.
Lastly is buy cash online.
Some insurance will reimbuse a cash purchase some will not. Cash purchase doesn't work with compliance requirements.
Bill my insurance.com can also get you what you want if your insurance will work with them. Contact them and ask.
A question though. Your insurance wanted you to pay $350? Is you insurance covering 100% with no deductable of the rest? If not then you have some math to do. How much will you owe total to the DME over the $350? The Remstar Auto (classic model not M) which is a great machine is $689 cash - no insurance. DO NOT PAY DME MORE than this.
Also, you may be at the end of the insurance year. Do you have and meet your deductable due to other medical expenses? or will you owe a deductable in 2007. You sound like your Insurance will let you make a purchase rather than Rent to own. If so definately call or email Bill My Insurance and call your insurance directly to see if they will cover a cash purchase that you make. Even an out of network coverage may net you less out of pockket cost that the local DME.
Run all the numbers and good luck.
Good luck
It took me 3 tries with the DME to get them to give me what was on my prescription. If you have the time and can stand to wait, keep calling them and bugging them. Tell different reps that you want what the doctor ordered.
For the most part the insurance company doesn't know the difference. Mine, considered APAP to be a Deluxe machine and they didn't cover it unless THEY decided you needed it. In reality, if the DME caves, the insurance company doesn't know or care.
The same billing code is used E0601 for CPAP is also used for APAP.
The key is one of two things. Letter of Medical necessity from Doc and maybe more discussion (if you want to bother your doc on this one) to get the insurance to cave. The Insurance co doc may overrule your doc (amazing as that may sound) or they may approve it. Some only approve it when CPAP fails. I don't like to recommend this route as you are taking something you don't really want from the DME and may have trouble getting coverage from another DME if the relationship sours.
Second way is hound the DME and hope they give what the prescription says. That is what I did. They called and said, we need to make an appointment for you to pick up your machine. I said, the one the doctor ordered. They said the Remstar Pro, I said I want the Remstar Auto my doc prescribed..... Then do it again, either they call you or you call them and initiate the conversation "I am supposed to get a Remstar Auto......)
Some people have had success all these ways
1) Doc supporting
2) Start CPAP and have problems
3) Hold out and hound the DME
Those are the basic choices as I see them.
Lastly is buy cash online.
Some insurance will reimbuse a cash purchase some will not. Cash purchase doesn't work with compliance requirements.
Bill my insurance.com can also get you what you want if your insurance will work with them. Contact them and ask.
A question though. Your insurance wanted you to pay $350? Is you insurance covering 100% with no deductable of the rest? If not then you have some math to do. How much will you owe total to the DME over the $350? The Remstar Auto (classic model not M) which is a great machine is $689 cash - no insurance. DO NOT PAY DME MORE than this.
Also, you may be at the end of the insurance year. Do you have and meet your deductable due to other medical expenses? or will you owe a deductable in 2007. You sound like your Insurance will let you make a purchase rather than Rent to own. If so definately call or email Bill My Insurance and call your insurance directly to see if they will cover a cash purchase that you make. Even an out of network coverage may net you less out of pockket cost that the local DME.
Run all the numbers and good luck.
Good luck
If you have no deductable as you say and will have no insurance after that. Get an AUTO however you can at the least cost to you. This will help eliminate unnecessary return trips to the doc or sleep lab which are expensive.
If you truly can get the Remstar Auto for $350 total with humidifier get it. But try playing hardball first to get it for less. If they are adding more for a humidifier then go buy cash because you probably won't save any money.
Check bill my insurance first.
If you truly can get the Remstar Auto for $350 total with humidifier get it. But try playing hardball first to get it for less. If they are adding more for a humidifier then go buy cash because you probably won't save any money.
Check bill my insurance first.
well I called them and they said to take it in to someone to put order in. And where ever I do take order to will put the request in. and either they will aprove it or not? my dme said that there was no code or auto period.
So after calling the 1-800 number for my medical and the lady saying put the order in. I started calling around to other dme and surprise surprise they said same thing that was posted in the forum. There is no diffeance and the code is the same. So had my doctor fax info to a different dme and lets see what happens now!!!
So after calling the 1-800 number for my medical and the lady saying put the order in. I started calling around to other dme and surprise surprise they said same thing that was posted in the forum. There is no diffeance and the code is the same. So had my doctor fax info to a different dme and lets see what happens now!!!
12 posts
• Page 1 of 1