CPAP Nightmare

[Idobelieveinfairies]

Hello All,

I’m hoping to get an idea of other people’s experiences so I can get a feel for what’s normal. My upfront experience of getting a CPAP machine has been so horrible—filled with rude providers, billing “errors,” and overall extreme incompetence—that I’ve long since relegated my machine to gather dust on my nightstand. Of course, since not a single person ever actually bothered discussing the severity (or not) of my symptoms with me, I’ve no idea if that’s a big deal or not.

When first receiving my machine from the referred provider (my first mistake), I was told I would be charged a monthly rental fee. My prior research online indicated I would end being charged, essentially, the full retail price over a number of months. That was not the case.

Instead, after lots of drama and months of incorrect billing—eventually culminating in them firing their billing provider—I’ve ended up with three charges of $2000+ apiece. In total, they’ve charged close to $7000 to my insurance, leaving me responsible for over $1600 out of pocket. For reference, the machine itself is a Philips Dreamstation, which I could buy online for maybe $900.

Am I wrong in thinking this is far, far outside the norm?

My second question is whether it’s possible to transfer my treatment—control of and data receipt from my machine—to a different provider. Both my original doctor’s office and the equipment provider are useless @$$holes beyond description, but I now have the world’s most expensive CPAP machine and I’m never able to use it.

Thanks for the help

[Julie]

Would help if you'd name the DME (some are great, some horrible) so we can compare notes.

[gv280z]

Ouch, that is rough, I'm sorry for your experience. You may have been penalized for compliance by the insurance company since you weren't using, (they wouldn't care that you were stuck in a confusing situation and needed guidance) and left you holding the bag.

Regardless if the data is being uploaded to anyone or not, please dust off that machine and put some new filters in it and start using, your apnea did not take a break from wrecking your life.

I went through Kelsey Seybold for mine with Cigna insurance and I think I paid around 8 or 900 out of pocket, (which I made payments on) not including mask and headgear.

[LSAT]

Have you discussed this with your insurance providor? Are looking at the bills from the DME or the POS showing what the insurance company actually paid them and what your obligation is?

[tsduke]

I can relate to some of your dilema. I kept having home sleep test, in lab sleep tests and machines ordered by either my regular doctor or ENT doctor. Neither of which explained anything to me. Never sat down to discuss the report. They just said here is your AHI and you need a machine. Was driving me nuts. Then after the titration study a VERY expensive Bipap was prescribed. I demanded more info and finally got referred to a sleep doc. I still have more questions for him, especially after reading here, but he was very informative. I got more info than I could remember.

I too have wondered how possible it is change DME's. I'm not impressed with mine.

Sorry, this is probably close to being a hijack, but it sure seems there is a lot people going through this process with no real provider/patient relationship working together for optimal treatment.

[babydinosnoreless]

You are not alone. Many of us have had bad experiences with the system. I got a back up machine here from LSAT for less than half of what I paid for my original one thru the DME. I only paid a small portion of what my insurance was paying
the DME. I was even forced by the DME into paying even more than what my insurance costs were and they are holding that several hundred dollars hostage until my machine is paid off in October (I expect they will have another excuse in October to not refund that money).

If you can afford it avoid the insurance companies all together and just buy your supplies online. Cpap.com is an honest company who charges fair prices and you get real parts. You can also get stuff cheep from Amazon or Ebay (I buy filters this way) but be watchful and read the reviews.

[NoOnesPerfect]

Regarding changing DME’s - it’s easy. Just send/give a copy of your prescription (or have your doctor do it) to the new DME or online vendor. It’s no different than going to a different pharmacy to get any other prescription filled.

[D.H.]

My first experience was a good one (back in 1999). The company came to my house and set up the machine. They replaced it because I kept complaining about it "conking out" momentarily. As it turned out, the problem was with my electric service. The electric company had to rewire my entire neighborhood (which they dutifully did at the time).

When it was time to get a new machine in 2005, I found that company was no longer selling CPAP machines (they were only selling medical equipment for critically ill patients).

The "preferred" provider on my insurance wanted $1500 (insurance would have covered 90%) for the machine I wanted and was giving me a hard time. I found an internet provider who sold it for $500 (of which the insurance would cover 70%). Thus, my out of pocket was the same. I went with the internet provider and the machine was shipped to me.

Machine #3 (2009) was ordered from the same place as machine #2.

For machine #4 (2016), I needed to go to a preferred provider, as my out-of-network coverage was considerably less than before. That was also a decent experience. Since I had a backup machine, I did not need to rush them. I paid less that $4 per month for thirteen months after which I owned the machine (Dream Station Auto).

[tsduke]

I'm still waiting to see what my share of the 10 month rent to own will be. All they could tell me was they would bill insurance $650/month for 10 months, but could not tell me what my network portion would be.

[Janknitz]

This is the information age. So you need to get some information.

FIRST: Contact your insurer and request your "evidence of coverage" (EOC) booklet (it may be available online or they must mail you a copy on request). That's the contract between you and your provider that you've never seen unless you know to ask for it. That will spell out in detail (assuming you understand the language insurers use) what the DME policy is for rental vs. purchase and your out of pocket expenses for same. Never, never, never, ever, ever, ever trust a DME to tell you the truth about your insurance coverage. Never pay a dime to a DME without an explanation of benefits (EOB) confirming your out of pocket expense. And then double check that the insurer is properly applying the rules in the EOC to your bills if they seem overly high.

The $650 per month the DME is "charging" for monthly rental is what we call "fantasy billing". It's what the DME would like to receive in their wildest dreams. But they are contracted providers with your insurer, and they are only going to get what the insurer decides is a reasonable cost for that item's monthly rental--a fraction of the fantasy charge. And you only have to pay the share of the insurer's contracted price as you are obligated with your insurer.

If there are double or even triple charges (sounds like it) you should contact your insurance company and file a complaint about the DME. Sounds like some fraudulent billing to me.

SECOND: You have a right to your sleep study report--the full report and not just the summary. Make a request in writing to the doctor who ordered the sleep study. You may have to pay for the copying, but you are entitled to it by law. If you want help understanding what it says and means, we can help you. You should have a good understanding of your OSA so that as you use the machine you will know how it's helping you. It's very motivating when you learn you stop breathing for 20 seconds or more 89 times a night and your oxygen levels go in the toilet. That's a stroke, heart attack and car accident waiting to happen. Bet you won't let that machine gather dust anymore!

Finally, the information the machine gives out is YOUR information. You should check with your insurer (or look in the EOC) about compliance requirements. If they have been documented as met, then YOU can control who has access to the data on your machine--you can access it yourself and learn what it means, and YOU can decide when and if your doctor or insurer or DME can have access to it. If you would post your equipment, we can tell you how.

[ChicagoGranny]

I'm still waiting to see what my share of the 10 month rent to own will be. All they could tell me was they would bill insurance $650/month for 10 months, but could not tell me what my network portion would be.

These are questions to address to your insurance company instead of the DME.

[tsduke]

Insurance can only if you know the charge codes otherwise good luck.

[Idobelieveinfairies]

To be clear, I don’t have concerns about how my insurance is covering this. My portion is my deductible, plus 20% of what’s left after that. Based on the available figures, that’s been done correctly.

The problem is this godawful equipment provider charging over $2000 a month for their “rental” fee. This hyperinflated billing is the reason my portion is so high, even after insurance. I’ve been trying to get answers from these people for almost a year, and they still can’t give me copies of itemized bills. Mostly they duck my calls or insist their “system isn’t working right now.”

So I guess the real question is, how much was your insurance billed for your machine? If it was a monthly “rental,” how much did they bill insurance for that?

[tsduke]

One thing my DME said is they could bill insurance the $650 they normally bill or $20,000. It woudl not matter as both would result in same agreed network price between them and insurance. The DME CAN'T, charge you anymore than that agreed upon network pricing.

[Pugsy]

So I guess the real question is, how much was your insurance billed for your machine? If it was a monthly “rental,” how much did they bill insurance for that?

Which brand and model machine are you using?
That will affect how much the insurance will allow. Different kinds of machines cost different amounts of money.
And it doesn't matter about the pie in the sky billed amount....the final contracted approved amount is the important factor.
Any amounts you pay or based on the approved amounts and not the pie in the sky billed amounts....and if for some reason they are trying to get you to pay the difference that shouldn't be allowed if they have a contract with your insurance company.