Going from a renter to a owner...?

zart · Post by **zart** » Thu Jun 30, 2005 8:10 pm

I have a question about insurance, rental and purchase of CPAP machine.

Right now I am renting a Remstar CPAP Pro with CFLEX and a heated humidifier. After reading about the option to own software that will show me how my treatment is progressing I think that when I buy a machine (which I think my insurance company should cover the full cost of since I have met my deductable) that I should buy a Remstar Pro 2. Am I right that this will give me a machine that I can get useful information out of? What are the chances that I will be able to get the better machine without hassels from the Insurance Co?

My insurance Co is Benecorp now but may change soon to BC/BS.

Anyone have any answers about this? any ideas?

chrisp · Post by **chrisp** » Thu Jun 30, 2005 8:23 pm

No buy the Remstar auto. You wont be disappointed. Leave the straight cpap for the DME.

:twis ted:

rested gal · Post by **rested gal** » Thu Jun 30, 2005 10:05 pm

Hi zart,

You are correct that the Pro 2 will be able to give you AHI data through software. The software is a separate purchase (no prescription needed to buy the software) and probably would not be covered by insurance even if the machine is covered.

Chris is correct too - cut to the chase, if you can. If you get an autopap, you'll have two machines in one. You can operate an autopap in either auto or straight cpap mode, whichever suits you best. An autopap takes a lot of the guesswork out of this kind of question in the future...."Is this pressure right for me?" An autopap is like having a mini sleep study at home, every night.

stetsongirl · Post by **stetsongirl** » Fri Jul 01, 2005 5:24 am

I do all the insurance verifications for a DME company. Here is the way that works. Insurance companies who allow you to rent the machine will allow it to be rented from the DME for x amount of time. Medicare is 15 months, some others are 10, or 12. At the end of that time you'll receive a letter asking if you want to continue renting or purchase the equipment. If you choose to purchase, then all the rental that insurance has paid in converted to purchase and it is considered your machine. The down side of that is if something goes wrong, you are responsible for repairing or replacing. If you choose the continued rental option, the insurance no longer pays monthly, but 2x a year they will pay a fee to the DME company to continue serving the equipment when needed. Ten years down the road if your machine is broken beyond repair, the DME company is responsible for replacing it with a brand new one. As a matter of fact, yesterday we had a man come in who is on vacation, his CPAP broke, he called his DME up north and they faxed us his prescription and we set him up with a brand new Respironics Pro 2. Now I don't think that's such a bad deal....?

mikemoran · Post by **mikemoran** » Fri Jul 01, 2005 5:49 am

stetsongirl wrote: Ten years down the road if your machine is broken beyond repair, the DME company is responsible for replacing it with a brand new one. As a matter of fact, yesterday we had a man come in who is on vacation, his CPAP broke, he called his DME up north and they faxed us his prescription and we set him up with a brand new Respironics Pro 2. Now I don't think that's such a bad deal....?

I don't work for a DME but I do do pricing professionally. If this was such a good deal why doesn't the insurance company pay twice a year for the warranty even if the machine is owned? They aren't paying the rent and as you said the previous rent went to ownership, it shouldn't matter if the machine is rented or owned to them. Makes you wonder how tied to the DMEs Insurance companies are. They help secure a revenue stream from the patient to the DME by paying for a warranty that cost them maybe 5% of the original value of the machine every year.

If rent to ownership occurs in 15 months, then in those ten years the man paid for his machine 7 times after it was already paid for by insurance. So he got to use an older technology for 10 years and paid for it over and over just in case it broke. Maybe if the machine was replaced 7 times during that period it might be worth it..

A person would be better off to take ownership and put what he would be paying in rent into an account and after 10 months can probably buy the best machine out there. Another 10 months and they have their own back up fund in case it breaks.

2listless · Post by **2listless** » Fri Jul 01, 2005 5:58 am

Rested Gal and chrisp make a good suggestion. The Remstar Auto with CFLEX is a great machine. You can use it as a straight CPAP, CPAP with CFLEX, AUTO or AUTO with CFLEX. The software is a must, and as Rested Gal stated, not covered by insurance. Plus you can get Derek's My Encore download to utilize with your Encore Pro software. It is a wonderful program and its information and graphs are spectacular....highly recommend that addition! However, you did not mention your pressure setting or if you are being treated for Central Apneas or any other health problems. You must consider all of those before switching to an auto

Stestsongirl absolutely laid out the insurance buyout exactly as it is. BCBS will rent for 10 months before you receive a letter asking if you want to rent or purchase. She is correct...if you purchase......you pay repairs and replacement. BCBS will allow an online purchase if you provide a letter of medical necessity, proof of compliance, plus providing them with a list of costs, equipment etc. along with a copy of your prescription. You then wait for a letter of approval before doing your purchase. Keep the original letters and make duplicates.....sometimes insurance companies have a short memory. Basically BCBS will not consider anything but rental if you have not utilized the equipment for a period of at least 5-6 months.
If you have already met your deductible, you might as well let the insurance keep paying for the rest of the year...nothing out of your pocket....then you have lots of time left to consider all your options and do more research. This is especially wise if your DME actually has been supportive and provides you with service. Good Luck!!!!!

zart · Post by **zart** » Fri Jul 01, 2005 6:12 am

How often do these machines break down or need to be replaced?

To tell you all the truth I can't afford to pay out my deductable every year. It is $2.500.00!! I was hoping that by the end of the year I could prove compliance and that the insurance co would purchase the machine thus saving me the rental cost next year... I already pay out $80.00 a month for medications, that doesn't count toward my deductable. What does it cost per month to rent?

My setting is at 10 and I am ashamed to say that I don't know any of the details about my sleep study no one has shared that information with me. I am not sure that I would understand it at this point but I am interested in learning. That is why I am interested in getting the software.

I really appreciate all the great information you all provide.

Thank you so much..

frostman · Post by **frostman** » Fri Jul 01, 2005 8:47 am

Very informative, things I didn't know. Let me see if I understand the process. I am with bcbs and signa together they pay about 96%. So in 10 months the insurance company sends me a letter to either keep renting or to own, they pay the balance, then its mine?? I pay repairs, etc. I would assume that mask replacement every 3 months, etc is still in place. I told my DME Lincare, I wanted at least the pro model so I could use the software. I now have the remstar plus, seems very good, but I might as well go all the way with an auto. Back to the issue. In 10 months the insurance companies will allow me to buy online or through any DME a new machine of my choice, and then its mine for repair, etc???

rested gal · Post by **rested gal** » Fri Jul 01, 2005 8:57 am

I told my DME Lincare, I wanted at least the pro model so I could use the software.

The Pro 2 (the "2" is very important) is the straight cpap model that will give the data you want to see.

It's my understanding that Respironics is discontinuing the Pro, in favor of manufacturing the Pro 2. So, if you do change to a "pro", be sure the DME doesn't give you an old Pro off their back shelves. Make sure it's a Pro 2.

wading thru the muck! · Post by **wading thru the muck!** » Fri Jul 01, 2005 8:57 am

Zart,

Like Chrisp said (and Rested Gal concured) buy the REMstar auto with C-flex. It runs around $800 for the machine and Humidifier from cpap.com. It will probably save you from needing another expensive sleep study down the road.

gracie97 · Post by **gracie97** » Fri Jul 01, 2005 10:27 pm

Just got CPAP today and brand new here.

What does DME stand for?

And the set up I was provided with (renting for 3 months due to insurance requirement) is a RemStar Pro 2 with C-flex and a RemStar pass over humidifier. Am renting from sleep clinic where testing was done. Technician told me this is $1700 set-up, but when I checked the web after getting home, I found it can be bought for about $700. Fretting because I don't recall if the papers I signed had some purchase agreement.

Sleep doctor said he "doesn't like to do rentals and sales but feels he has to so people wind up with the right equipment."

In uncomfortable position, I guess, of having to tell sleep specialist that I want to return his machine and get a prescription to buy the same machine elsehwere.

2listless · Post by **2listless** » Sat Jul 02, 2005 8:26 am

DME = Durable Medical Equipment, used to refer to basically a Home Health Care Supplier of medical equipment

The Letter referred to should come from the DME, not the insurance. By Law, the DME must present you with the option.

I have no idea how long a piece of Medical Equipment will last......depends if you drop it on the floor I guess.......

My deductible is $285..which is taken care of by my yearly cardiac and pulmonary tests...instantly uses up the deductible. Remember that there are millions of different insurance polices all requiring different deductibles. Also makes a difference if you are in a PPO or need to be in the system.

However, if you have already met the deductible for the year....wear out their equipment for the rest of the year, in the meantime work with your insurance to get preapproval for an online purchase........remember, this is an insurance company....it will take a LONG TIME, so start now so you have new equipment on Dec. 31st!

Masks are replaceable every 3 or 6 monhs depending on your policy. Your insurance purchases it outright..it is considered consumable..not returnable. Believe it or not, the insurance approves and pays a flat rate on all masks $115..the DME will bill a lot more than that so they get the full $115. Headgear is purchased separately....insurance approves something over $30 for it. Hoses, filters etc are all separate. It is just an insurance game...DME overprices, BCBS removes their BCBS provider amount and ends up paying the ampunt the DME wanted anyway. Normal business. I guess it boils down to how much your deductible amount is.....if it is low, let the insurance pay rental all you want. My durable medical equipment is paid 100% by the insurance...no out of pocket expense. Just the aggravation of dealing with endless incorrect billing which I now ignore. It is the DME's problem.

You need to look at it from a financial viewpoint...what is your best financial decision. Without looking at my notes because I am too tired to move, I believe BCBS said that I would own the machine after 2 years of rental but if it then brokedown that I am eligible for a new machine. I cannot swear to that last piece of information....all I can yank off the top of my head is..after a specific length of time, you own the machine anyway...again, depending on your policy.

Okay, even I am confused now!!!!

stetsongirl · Post by **stetsongirl** » Sat Jul 02, 2005 3:33 pm

mikemoran, a little miscommunication here. If the machine is purchased, there is no 'warranty', you purchase, you pay for repairs. If you choose the continued rental option, instead of paying let say $125 month rent, then every 6 months the DME is paid that approximate amount to continue service on the machine. So if it breaks, gets old, or you drop it in the bathtub (gosh, hope that doesn't happen) the DME will replace it. Hope that clears it up. BTW, I did an overnight oximetry on my husband the other night and his O2 went down to 82%. We have him scheduled for a sleep study August 5 and 6. His symptoms aren't the same as mine. He goes like a tornado all day. By the end of the day he's tired, but I would be too following him around all day. He snores, he has trouble staying awake when he drives, but his biggest complaint is that his legs constantly hurt, feel like he's about to get a bad cramp but it never comes. As anyone else experienced that?

Janelle · Post by **Janelle** » Sat Jul 02, 2005 6:39 pm

BCBS rents for a year? Not mine. 2months! My Insurance said they rent for 2 and then pay off the rest to purchase the machine. I was never given an option to keep on renting. I got a letter from the DME saying I was now the owner. When I called the insurance to ask about ordering machines, etc.online, they said the same thing applied. They would deduct my deductible, any amounts that had been paid on rental and would pay up to the allowable upon being sent a copy of the bill from the provider with the necessary codes. They already had the letter of medical necessity and the RX from the DME and Dr. They also said, the same would apply to future purchases. I have BCBS Federal and BCBS State (Texas).

The machine is warranteed by the manufacturer for like 2 years. But if it is bought from the DME, we have to return it to them for service, right? Because the manufacturer requires us to go through them for warranty repair or replacement. Why would there no longer be a warranty if we buy it? That makes no sense. The manufacturer's warranty is still in place whether we rent or buy. If we rent and do not buy then the DME would have to repair or replace for the length of the rental.

christinequilts · Post by **christinequilts** » Sat Jul 02, 2005 7:38 pm

stetsongirl wrote: If the machine is purchased, there is no 'warranty', you purchase, you pay for repairs. If you choose the continued rental option, instead of paying let say $125 month rent, then every 6 months the DME is paid that approximate amount to continue service on the machine. So if it breaks, gets old, or you drop it in the bathtub (gosh, hope that doesn't happen) the DME will replace it.

I have Medicare due to disability and since I hope one day to be able to return to work I choose to switch my other medical equipment to purchase but for most people on Medicare the maintenance-rental makes more sense. On the maintenance/rental plan Medicare pays 1 months rental every 6 months to cover all maintenance and/or replacement. If you chose ownership Medicare will pay rental for a few more months and then will only pay for medical necessary repairs. I've never had any major problems with my other medical equipment since I've taken ownership other then needing a new plastic cover on the enteral feeding pump- it holds the bag set tubing in place so it wasn't just a cosmetic issue. Instead of sending it in for repair I told my DME what was needed and they ordered it for me and never billed me or my insurance.

My BiPAP ST unfortunetly falls into a different category with Medicare so it will be rental forever. They classify it as needing a higher level of support & maintenance then most medical equipment.

As for your husbands description of his legs you might want to do a search on restless leg syndrome/periodic limb movement. It can be a problem on its own but it can also be a symptom of sleep apnea too.

Going from a renter to a owner...?

Going from a renter to a owner...?

Going from a renter to a owner...?

Re: Going from a renter to a owner...?

owning machine

Great Topic - Rent and Then Own

renting from sleep clinic

Insurance

Going from a renter to an owner....

Re: Going from a renter to an owner....