How do y'all afford all this stuff??!

[plr66]

Sorry I am so in the dark, but I guess I just don't get some simple concepts where insurance is concerned. I have $1000 deductible. Aside from this new diagnosis of OSA, I have relatively few medical appt's each year. This year, my $1000 deductible has not even had a penny paid down, despite a number of medical appts.

And I listen to so many of you here talk about getting new machines and masks and this, that, and the other accessories every 6-12 months, and I can't figure out how you do it! Given the time of year (with just 3 months remaining), I will be paying out of pocket for the entire bill for the CPAP machine, HH, mask, and what-nots. Come next year, there will be nothing different that will pay down that huge deductible, I am assuming/hoping....so any additional changes in equipment will also be out of pocket, and so it will go. What secrets have you all?

[yorkiemum01]

Hi Plr66,
Wish I had 'secrets' to share, but only my own experience. I too, have a high deductible
insurance, $2500/annually and all DME is applied to my deductible. Since I am new to CPAP
this year, I rented my equiptment until I found what suited me, than bought through a private
seller on this forum.
It seems most folks struggle with the mask setup, although I was forturnate there, as a mouth
breather, knew I needed a full face mask. Once I knew which mask/machine I wanted, I shopped,
either with cpapauction.com, ebay, craigslist, and word of mouth here on the forum. Its been a
costly venture, but I'd rather invest in knowing what was best suited for me long term, and purchase
outright as the price difference between my insurance and my cash transactions in the long run, paid off.
My insurance required a 14 month rental of the cpap for $111.99 a month approved amount, not to mention
the humidifier, mask, filters, hose, and all the equiptment. Thankfully, I'm returning their cpap to them
next week, with the support of my physician, as I've purchased a Vantage relatively new from a forum member.
Hope some of this information is helpful. Be well.

[OutaSync]

I guess I'm lucky. My insurance paid for the two sleep studies and 100% of my equipment up to $2400 a year. There was no deductible for medical equipment. Of course I have paid for 10 of my masks myself, as they will not cover anything I buy online and I was desperate to find a mask that fit. Even so, it has been expensive, what with the pillows, bed wedge, multible tapes, polident strips, lanolin, glue, pur-sleep oils, chinstraps, hose hangers, melatonin, Ambien, Neilmed sinus rinse, hose covers, mask strap covers, disinfectant mask wipes, etc.

I've been paying my insurance premiums all my like and this is the first time I've really had a need for it, so I keep telling myself that my health is worth it.

Bev

[Goofproof]

Insurance comes in many forms, If you have a high deductable it's because you have a low INS premium, or you made a bad choice. Some of us have good INS, some do not, and some have none. We all have to row the boat we brung. By not smoking or drinking, I can buy what I need, but I never took vacations, and my cars (2) are 30 years old, I worked my tail off, but it's still too big. Life is Choices. I buy where, and when the price and vaule are the best. If I can't afford something I don't buy it. Jim

[plr66]

Insurance comes in many forms, If you have a high deductable it's because you have a low INS premium, or you made a bad choice. Some of us have good INS, some do not, and some have none. We all have to row the boat we brung. By not smoking or drinking, I can buy what I need, but I never took vacations, and my cars (2) are 30 years old, I worked my tail off, but it's still too big. Life is Choices. I buy where, and when the price and vaule are the best. If I can't afford something I don't buy it. Jim

Jim, I hate to respond defensively, but it seems unfortunately built into your response. I didn't choose my insurance. It came with my employment. I am not taking issue with what I need to do for my health. I will do what I need to do, Period. I sometimes feel that old-timers here may respond to newcomers as if we need preaching to. I do not. Thanks. I'm really committed to this, and very much looking forward to the positive changes I hear others talking about.

On other threads I have been trying to understand whether it makes sense to can the brick & mortar DME agency where I can return things, get trouble-shooting help, etc. in favor of the large price savings of purchasing online. My question relates completely to that issue. I have had to try a number of masks from my DME. If I bought them online, I guess they would be non-returnable. So I am just needing some practical financial savvy here about how it pans out one way against the other. And the other puzzle to me is that some folks here say they can replace their CPAP every so many months....how is that possible?

[RosemaryB]

I decided that this was my top priority health issue and worked to see what worked best, since I spend 1/3 of my life using the equipment.

Early on I did a lot of trading from the Mask Roulette thread that people were using on this forum. That's how I afforded to try some different masks, since it was just the cost of postage. I also tried some masks via auction. I did buy the Headrest new, but I bought it from cpap.com, so it was considerably cheaper than it would have been at my local DME. Most DME's don't carry that mask anyway.

Another thing I did very early on was to find a mask fitting clinic at a hospital in a nearby town (the town where I live had none). I had to call around, but found two one that was free and the other that was not very expensive. I went with a list of likely masks and also asked the (very good) tech for his recommendations. I got to try on a number and wrote down which ones to rule out, plus the top one to try.

Getting this right is a lot of work, but so worth it. I feel like a different person now that I've been well rested for about 1 1/2 years.

[RosemaryB]

On other threads I have been trying to understand whether it makes sense to can the brick & mortar DME agency where I can return things, get trouble-shooting help, etc. in favor of the large price savings of purchasing online. My question relates completely to that issue. I have had to try a number of masks from my DME. If I bought them online, I guess they would be non-returnable. So I am just needing some practical financial savvy here about how it pans out one way against the other. And the other puzzle to me is that some folks here say they can replace their CPAP every so many months....how is that possible?

You posted while I was writing the above, so I wanted to add a few things. It sounds like you have been able to return a number of masks from your local DME, and that is good. I'm assuming you've only had to pay for one. Once you find a mask that works for you, you don't need to replace it that often, and you can buy the replacements online, along with supplies like filters, hoses, etc.

I don't think most of us can replace our cpaps every so many months, however. Most insurance will only pay to replace it every five years. Sometimes people have more than one machine in order to have a travel machine or a backup machine. You can find good deals on machines via auctions. You have to take care with cpapauction.com sellers just as you would on ebay. It's the same deal.

There are some very frugal people on here that get the maximum use out of their equipment and use their masks for a year or more. Once you get started, you can ask for advice about making your equipment last as long as possible.

I'm glad you are so committed to this.

[jules]

There is a lot of expense at first, however once you are in the swing, there isn't much in my experience.

Insurance will pay on a new machine every 5 years usually (your policy will vary of course), so how often will you replace your machine?

If you want to keep having the latest new model, well then your costs will go up. If you upgrade your machine, you might need to upgrade the software too.

Most of us have had insurance that is dependent on where we work, however, we also choose where we work and accept what is offered.

My biggest beefs right now are having to accept Medicare when I reach 65 based on my spouse's work (I was promised insurance for life if I put in the years which I did) and that each year in the interim the cost for insurance goes up, the copays go up, and the coverage goes way down.

[jnk]

" . . . What secrets have you all?"

". . . hate to respond defensively . . . old-timers here may respond to newcomers as if we need preaching to . . . "

When asked for secrets, Goofproof gave his. And they are good ones. And he was preaching to all of us, I think. And some of us need it.

Amen, Brother Goofproof.

But, hey, we all get defensive sometimes. Well, not me of course. If anybody ever called me defensive, well, I'd sure let them know about it, I would, 'cause I don't stand for that! Oh, sorry. Anyway. . . .

Thanks from the rest of us for the post, Goofproof. I liked it.

[Bookbear]

plr66, check the prices on cpap.com and other on-line dealers carefully and compare to what the DME will be charging you. I will be willing to be that you can easily beat the $1000 cost to you (your deductable) for the same equipment. Since you have a high deductable, it makes sense to bypass the insurance for your equipment and purchase outright and get the equipment you want; especially given that you are in the last three months of the year and that deductable amount will reset in January.

If you needed a very expensive unit such as a vpap or bi-level unit, then yes, use the insurance, pay the $1000 and let the insurance pick up the rest. But if you need a cpap or apap, it sounds like you would be better off buying yourself on line (lower price by far), than paying the DME's price that will cost you at lest the $1000.

Good luck!

[Bearded_One]

I am fortunate that I have sufficient income for me to buy new equipment when I decide that I need or want to buy new equipment. Some people buy expensive cars, TVs and stereos, I buy CPAP equipment. Actually, I have spent less on all of my CPAP equipment than what many people pay for a large plasma or LCD TV.

[ww]

Sorry I am so in the dark, but I guess I just don't get some simple concepts where insurance is concerned. I have $1000 deductible. Aside from this new diagnosis of OSA, I have relatively few medical appt's each year. This year, my $1000 deductible has not even had a penny paid down, despite a number of medical appts.

And I listen to so many of you here talk about getting new machines and masks and this, that, and the other accessories every 6-12 months, and I can't figure out how you do it! Given the time of year (with just 3 months remaining), I will be paying out of pocket for the entire bill for the CPAP machine, HH, mask, and what-nots. Come next year, there will be nothing different that will pay down that huge deductible, I am assuming/hoping....so any additional changes in equipment will also be out of pocket, and so it will go. What secrets have you all?

I guess it is all in your perspective. 2 Nexium pills a day for my wife paid in the donut hole our wonderful government left for seniors costs $900 for 3 months and the premiums are still over $300/for those 3 month, then there is the supplement insurance at $200 a month. Most things cost less without any insurance!

A great Auto CPAP machine with humidifie, premium hose, hose cover, software, card reader and a couple of really nice masks with strap covers and most accessories you can think of costs less than $1200 or $100 a month. Buy everything direct from cpap.com. With a DME and your deductible you will spend considerably more than that. That seems pretty inexpensive with or without insurance for all the good that it does for your health. Nearly all of the unexplained problems (everything falling apart) including high blood pressure went away with CPAP therapy. I didn't really think an APAP was required, but time has proven it was worth far more than I would have ever thought, but without software, I would never have realized the difference! Good Luck.

[Goofproof]

[quote="plr66 Jim, I hate to respond defensively, but it seems unfortunately built into your response. I didn't choose my insurance. It came with my employment. I am not taking issue with what I need to do for my health. I will do what I need to do, Period. I sometimes feel that old-timers here may respond to newcomers as if we need preaching to. I do not. Thanks. I'm really committed to this, and very much looking forward to the positive changes I hear others talking about.

On other threads I have been trying to understand whether it makes sense to can the brick & mortar DME agency where I can return things, get trouble-shooting help, etc. in favor of the large price savings of purchasing online. My question relates completely to that issue. I have had to try a number of masks from my DME. If I bought them online, I guess they would be non-returnable. So I am just needing some practical financial savvy here about how it pans out one way against the other. And the other puzzle to me is that some folks here say they can replace their CPAP every so many months....how is that possible?[/quote]

I understand, because I too had crappy INS, due to medical ins bills, I jumped ship, and changed job fields, to secure better INS for my family. I now have good ins, but in the process I gained poor health in doing so, but If I hadn't, I'd been on welfare and dead. In the last thirty years my medical bills have been around $500,000 Retail, no way can you keep up with that by yourself. I only hope my kids never run into that kind of wall. Life can be tough, you just have to make the best of it, and try to choose the doors that keep you moving forward. Jim

[Wulfman]

And the other puzzle to me is that some folks here say they can replace their CPAP every so many months....how is that possible?

Quite possible you were thinking about the masks and not the machines.....?

Well, I have reasonably good insurance coverage, but a $750 deductible. In 2005, when I went through my sleep study and started on this journey, it was the only time I've met my deductible with this employer and about 12 years since I'd been to a doctor. Since I haven't been spending my money on doctors, I've been able to save it. My insurance provider reimbursed me for 80% of my equipment purchase from CPAP.COM that year. In a roundabout way, I used that reimbursement to purchase an additional (lightly used) Auto/APAP the following year for a backup machine. I also used the following year's deductible (that I'd saved) and purchased one more Auto and several additional masks, seals, filters, etc. that year (2006). I did the same thing in 2007 (when the Legacy model machines were being phased out). I believe I'm done buying CPAP "stuff" for a long, long time. As I indicated, I purchased all of the additional equipment and supplies out-of-pocket in '06 and '07. I also have not been back to a doctor since Oct. of 2005 (and that wasn't my sleep doctor).

I know SOMEBODY is benefiting from the hundreds of dollars in insurance premiums that are withheld from my paycheck each month.......but it ain't me.


Den

[jules]

I guess it is all in your perspective. 2 Nexium pills a day for my wife paid in the donut hole our wonderful government left for seniors costs $900 for 3 months and the premiums are still over $300/for those 3 month, then there is the supplement insurance at $200 a month. Most things cost less without any insurance!

My insurance is paid for as I am a retired state employee - I pay for my spouse's. When we reach 65, then we will have to pay for Medicare too. My insurance coverage becomes secondary, but I have yet to be convinced we will be saving money in the long run.

As opposed to Den, I have met my deductible many years and actually reached my "max out of pocket" a few of them but not since the year I went on cpap. My spouse however, doesn't get close on either usually.

This Rx coverage for Medicare has lot of holes I gather. I do get to keep my Rx coverage so I don't have to deal with Medicare Part D - well by the time I reach 65 I am sure that will all change and we will lose all the coverage we were promised long ago.

Where I live the one local doctor is probably leaving (I am not his patient right now anyhow) because he feels he can't even break even with the large number of Medicare and Public Aid patients in his practice. The whole system needs to change.