Insurance snag !!

[SNORENOMORE2]

HI everyone.Hope all are doing well.Well folks I've been presented a bit of a problem.I've been into therapy since about Oct. 2006.The cost of my equipment is a 50/50 split with my present insurance coverage(thru employer) with the option of a 13 month installment payment of my half to the DME people which I've decieded to take advantage of...unable to dish out the total cost at present.I'm about $300.00 into the DME with a good amount to go yet .Now I've been informed by my employer that they are dropping our present ins. provider(cost cutting move)in favor of another at the end of Feb 2007.New insurance provider has a 0 copay for durable equipment,but doesn't deal with present DME.Has anyone been in a situation where they returned equipment to one DME so as to restart with new ins. and DME and if so what problems were encoutered.This present DME seems to have already caught wind of what's about to happen and are calling me to rush co-pays.Any info greatly appreciated. Take care all.

Harry

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

[Snoredog]

after a while you figure it out that it simply doesn't pay to deal with insurance and copays, had you applied that money towards a purchase of an autopap of your choice, you would be half way done paying for it.

at this point, you probably have to return the machine and forfeit monies paid and start over or continue with the 13 month rental out of your own pocket.

when you have any copays, insurance pretty much screws you into paying for the machine anyway by forcing you to use their so called contract DME's and paying a portion of their over inflated ripoff prices.

you don't get any added value paying twice as much for your equipment then being restricted with any changes or not getting the manuals to the machine.

you can buy the top of the line autopap for 600 bucks from any online provider.

if your insurance forces you to pay 1500 for a 600 dollar machine then a 50% copay what are you saving?

[oldgearhead]

My 2006 out-of-pocket xPAP expenses total was $875.00, and that includes
a used, low-mileage APAP. Furthermore, I do have pretty good insurance,
but my life is better without the DME, and the cost is actually a bit lower...

My out-of-pocket expense for my 2006 sleep study was more than
I spent for equipment, and the PSG cost was split: 30% write off, 40%
insurance, and 30% me.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, APAP

[Slinky]

HI everyone.Hope all are doing well.Well folks I've been presented a bit of a problem.I've been into therapy since about Oct. 2006.The cost of my equipment is a 50/50 split with my present insurance coverage(thru employer) with the option of a 13 month installment payment of my half to the DME people which I've decieded to take advantage of...unable to dish out the total cost at present.I'm about $300.00 into the DME with a good amount to go yet .Now I've been informed by my employer that they are dropping our present ins. provider(cost cutting move)in favor of another at the end of Feb 2007.New insurance provider has a 0 copay for durable equipment,but doesn't deal with present DME.Has anyone been in a situation where they returned equipment to one DME so as to restart with new ins. and DME and if so what problems were encoutered.This present DME seems to have already caught wind of what's about to happen and are calling me to rush co-pays.Any info greatly appreciated. Take cae all.

I'm taking a guess here but from the way you explained it, your present insurance company (until end of this month) most likely paid their share in full, and the 13 month installment for your co-pay was a negotiation you made w/the DME.

BUT to be sure I would call your present insurance company as there are "capped rental" options and it may be your present insurance company then also went w/the "capped rental" and have only paid their Oct thru Feb rental costs for the xPAP machine (but paid 50% for all the rest of your equipment, including humidifier in full). Have you gotten any statements from your current insurance company as to what they have paid?

You should also contact your Benefits Rep at your place of employement and present this problem to him/her. He/she may be able to help you w/this predicament.

The one you CAN'T believe is your current DME. I doubt that the new insurance company is going to talk to you UNTIL AFTER your new coverage goes into effect so I don't know that they would be of any help to you - but your Benefits Rep may have some input there that could be of help.

If all else fails and you haven't found a way off the hook w/your current DME, negotiate w/them. Keep in mind and point out to them: Oct thru Feb is 5 months at $300 a month (and that is just YOUR share) is $1500. PLUS whatever your insurance has paid. If they just let you return your xPAP they've received their cost of the machine and if they take it back they then have a used machine they can use for a temporary loaner that has already been paid for. Keep in mind: the insurance paid outright 50% of all the other equipment, including humidifier and some of your $300 a month most likely went towards that as well (unless you also paid a good chunk up front for the equipment that was sold outright). Either way, they have received at least $3000 for everything they provided to you given your current 50%/50% insurance coverage.

So much depends on whether this ended up being a "capped rental" or an outright purchase w/the purchase agreement stipulating your 50% would be a monthy payment.

Dig out all your paperwork from your current DME so you have it in hand when you talk to your Benefits Rep and your current insurance. You need to know just exactly what kind of purchase this was, total cost and total payments to end of Feb '07.

Ooops! I should have clarified: your insurance company does NOT pay the BILLED costs, they've negotiated that down considerably when they contracted w/this DME. So another thing to consider is whether you are paying 50% of the BILLED amount or %50 of the allowed (by insurance) amount.

Also: I've been seeing brand new RemStar Auto w/C-Flex PAPs selling, brand new in the box sealed in plastic with humidifier, manualS and data card for $450 at yahooauctions the last few months. (Someone did bid one up to $520 - but only the one, the rest all went at $450).

[JimW]

New insurance provider has a 0 copay for durable equipment,but doesn't deal with present DME.

What I would do in this situation, given my hindsight, would depend on some other variables.

1. You have a 0 copay. Do you have a deductible amount for the new year on durable equipment? If so, what is it? How does this stack up against purchasing a new machine online, as has already been suggested. (Also, if you have a deductible, if it wasn't spent on xPAP, how likely are you to end up paying it during the year in any event?)

2. How good is your current equipment? Does it do everything you want it to do? Personally, with the knowledge and experience I've gained, I'd definitely want an APAP, or at least a data-capable CPAP.

3. How much would you have to pay to purchase your current machine, assuming that it meets your needs? I estimate $675 based on the information you've given. (Given that you state that you're not able to do this out-of-pocket, if you choose this option, will the DME accept payments?) Will your current insurance convert into a purchase? Depending on your credit status, unless your current machine is truly an excellent one, I'd look long and hard at the option suggested by Snoredog. For that $675, you can get an APAP with heated humidifier. (This is, of course, dependent also on your answers to 1 and 4.)

4. Will your new insurance/potential new DME provide you with a machine which meets your needs? (In my situation, I had to be a little proactive to obtain my current machine, which was provided without copay or deductible.)