Good grief!!!

Huntsman · Post by **Huntsman** » Thu Oct 11, 2007 9:55 pm

Well I got the call today to come in for setup with my machine tomorrow! Kind of excited and hoping that I will get a repeat of the great nights sleep I had at the sleep lab tomorrow night and wake up feeling just as good as I did before!

No clue as yet as to what machine or anything, and I didn't think to ask when the DME called. I did however start wondering how much this was going to cost me after I got off the phone so did a little research...I've got BCBS and from what I've read they do not buy the machine but instead rent it? Holy cow! Did more reading and it seems they are willing to pay thousands a year to rent a machine that they could buy for 6-700 dollars!
That lead me into finding information on how a lot of DMEs it seems are overcharging for accessories!

Well...I'll find out tomorrow. If I get the impression that my insurance is being overcharged, which in turn will mean me being overcharged in co-pays, I will get the machine they have temporarily and return it after I buy one from an online supplier.

Dang, this has me mad enough to spit! No wonder insurance is so expensive!

alpha1340 · Post by **alpha1340** » Thu Oct 11, 2007 10:30 pm

I would find out how much your insurance pays. They typically only rent the machine for X amount of months then the machine is yours. My BCBS rents the machine for 10months which mine is up this month and then the machine is mine outright. My copay is 80/20 which means insurance pays 80% of the rental cost and I pay 20% since i had already met my deductible when i started it ended up working better for me to go with insurance since i was only out less than $100 for the machine and humidifier than i would get from an online dme i ended up switching my machine out after two months to get the mseries auto instead of the f&p 234 that they originally gave me and my doc had no problem writing the script for that because she is happy that patients want to take their treatment under their own.

I wouldn't settle for anything less than a fully data capable machine. Some people say to get an auto because you can run it in either straight cpap or auto when you might need adjusting. Cpap.com has a mseries auto setup for about $600 i think so just weigh how much you would be paying out with insurance versus buying online. Also with cpap.com anything over $100 is free shipping and they are speedy on the shipping process.

Also make sure to get a complete report of your titration not just the summary and a copy of your perscription that way when you do goto buy online you will be prepared.

By the way welcome to the hosehead club.

snoregirl · Post by **snoregirl** » Thu Oct 11, 2007 10:52 pm

I would be careful of taking something you don't want "temporarily" as it is then harder to change or get another DME to deal with you.

Billmyinsurance for example won't touch you once you start with someone else.

So if they offer a non data machine, walk away.

You can have yours from an online vendor in a day or so of you want overnight shipping.

ColoradoDreamer · Post by **ColoradoDreamer** » Thu Oct 11, 2007 11:25 pm

I too have BCBS. They do rent the machine for first time users but it is a rent-to-own arrangement. After 10 months you will own the machine. They will not rent it forever. BCBS will allow you to own it sooner if you demonstrate that you are compliant (so you don't have to make another deductible payment in Jan) but your DME may not like that as they did with me.

Also, be prepared for the price that the DME will put on the invoice. My invoice showed that they were charging over double the price at cpap.com for just about everything. BCBS does not pay this amount. When you get your first insurance claim from BCBS you will see that what the insurance actually pays is reasonable and in some cases less than cpap.com. If you want to know what the insurance is paying for your machine just multiply it by 10. The same will be true for your copay (assuming you already payed the deductible with the sleep study).

Agree with others that you take a close look at the cpap they offer you. If the offer the Respironics M Series devices, go with nothing less than the "Pro" if you plan on monitoring yourself with the smart card and software.

tuna · Post by **tuna** » Thu Oct 11, 2007 11:54 pm

Federal Employee's BCBS didn't rent mine, it was a purchase, then i get me a better machine out of pocket.. every month the DME called and ask if I am compliant. They just take my word for it..

DreamDiver · Post by **DreamDiver** » Fri Oct 12, 2007 1:14 am

If you have an idea what you want on your machine, ask for it.
For instance, my DME usually does the M Series Plus.
I asked for the Pro. Apparently, my insurance allows for it
because the DME was happy to oblige.

skits · Post by **skits** » Fri Oct 12, 2007 9:15 am

I have a Remstar Auto M Series. How do I know if it's a plus or a pro or nothing at all?

My insurance is doing a rent to own too. Looks like $75 will be my out-of-pocket.

Wulfman · Post by **Wulfman** » Fri Oct 12, 2007 9:38 am

Depending on which BCBS plan/group you are in, I've read on the forum that BCBS will reimburse YOU for out-of-pocket purchases (like from CPAP.COM) as they would consider YOU to be "in-network". The only thing you would have to do is to make out an invoice to them (BCBS) as the party being billed and being from you as the billing party. The invoice you'd receive from CPAP.COM has all of the billing codes on it, so you could use theirs to create your invoice.
I don't have BCBS, but this is what I did and got reimbursed 80% from my insurance provider.

Call your insurance provider and ask them if they'll do that.

Den

rested gal · Post by **rested gal** » Fri Oct 12, 2007 11:43 am

skits wrote:I have a Remstar Auto M Series. How do I know if it's a plus or a pro or nothing at all?

The full name of the machine is always written out completely on the top surface of the machine.

Yours, for example, is an autopap and probably has this written on top:

Respironics REMstar Auto M series (those have C-Flex built into them.)

If it were the autopap model with A-flex it would say this on top:

Respironics REMstar Auto / A-Flex M series.

No Respironics autopap will have "Plus" or "Pro" in its name.

The M series machines that have Plus or Pro in their names are not autopaps. They are "CPAP" machines that blow one single pressure all the time.

The most basic of the two Respironics "cpap" machines is the Plus. It's considered basic because all it can record onto a Smart Card is hours of use. The Pro records more detailed information. Either of those two "cpap" machines gives the same treatment exactly. The difference is in the amount of information they can give.

The Autopap records detailed info, too, btw.

snoregirl · Post by **snoregirl** » Fri Oct 12, 2007 12:57 pm

To the original poster.....

Another thing to watch out for given the time of year it is again, is 2008 deductable if you have a deductable and if your insurance runs on the calendar year.

If you start too close to the end of the year you may have to satisfy your deductable in 2008 while BC/BS is still renting. Add that to your out of pocket cost for comparisons.

Huntsman · Post by **Huntsman** » Fri Oct 12, 2007 4:39 pm

Thanks for the input folks, I feel a little silly now after meeting the people at the DME and picking up the machine. They were extrememly friendly and brought the machine out in an unopened factory box. From reading here I had an idea of what I wanted either the Remstar PLus or preferably the Pro, the one they brought out was the Plus with the humidifier. First question was if they had a Pro and if so could I get that one, they only had one other machine with the full data capability and it was a brand I had not read about here, so I went with the Plus unit they brought out. They unpacked the box with me and went over what all the bits and pieces were, how to use it and stuff. I asked about the insurance setup and they already had the info from my BCBS plan. Machine is rented initially and length of rental is determined by my compliance. I asked about the compliance and they said that if the insurance company asks for it they will either come by and read the card or I can bring it by, but that with my insurance they would probably not need to download the card, and generally they turned over the machine within 2-3 months.

When they filled out the invoices they did separate each item and bill it on a separate line(hose, mask, machine, humidifier) even though it all came out of the same box, however the total was not exhorbitant(I understand that a brick and mortar has overhead to cover). And if the rental goes 3 months the monthly fees will not come to what the invoice total was, my portion will figure out to about $110 overall. So I have to say I was relieved a bit, they seem like a good place, and told me if I had any problems at all with mask or whatever to let them know and they'd set me up with whatever I needed to make it work for me.

I did feel a bit guilty during the technical portion where they showed me how to use it...I R Un injunear after all and things with buttons are my speciality! Plus I had already read enough on here to choke a horse.

Hrmmm...just flipped on the TV and Star Wars is on...I've already got steel reinforced arteries in the old ticker...now the breathing machine...(Darth Vader voice) "My journey to the dark side is almost complete!"

Mask

Good grief!!!

Good grief!!!

Ask the DME