I am now DME-free!

[jnk]

I had discussions with my medical and insurance contacts today and made a case for my being permanently freed from my DME and being allowed to buy my own supplies (filters/masks/hoses/etc) online instead. I sent them links to what I forsaw myself ordering from cpap.com, and I told them that I would limit the frequency of my purchases to what is outlined in Medicare's allowed-replacement schedule as a model schedule, but that I didn't foresee my needing a mask more often than once every six months or so. They agreed to put a note in my file to that effect and said that all I have to do is send them the receipts and they will reimburse me in full directly.

I am sure many of you have probably had similar arrangements in place for a long time for yourself, but I still wanted to share my personal joy at never having to deal with the wacky people at my former sorry-excuse-for-a-DME again.

YMMV,

jeff

[Slinky]

CONGRATULATIONS, jnk!!! I wish I could set up a similar arrangement w/Medicare and UAW BC/BS!!!!

[goose]

Right on Jeff!!!!
That's one to keep in the back pocket for the time (soon to come) I have to deal with Medicare....

Which reminds me -- my DME called today asking if I needed any supplies. Must need to make their numbers for December. I'll give 'em a call on Monday with my "needs".....Going to try an Activa mask this time.... We'll see....

I may have to query my insurance company again about covering cpap.com.....they'd sure save a significant amount of $$$!!!!

cheers
goose

[GumbyCT]

JNK may I ask who your Insurer is?
And Congrats. Way to goooo.. wooohoo

[plr66]

Jeff, are you saying that you somehow got your insurance company to change cpap.com from out-of-network status to an in-network provider in order to get that promise to cover 100% ? I am very interested in all the details of what department and what level of the bureaucracy you contacted to be able to accomplish this. Really! I have $1500 deductible for in-network and $2000 for out of network. Was at zero paid toward deductible when diagnosed with OSA in August, and the numbers and DME craziness just led me to bite the bullet and pay for everything out of pocket from cpap.com. Now that my deductible has been met, insurance will only pick up 70% of their allowed rate on any cpap.com purchases I now make before Jan 1st. As I cannot foresee ever using a local DME again, I sure would like to know your magic!

(Edited to correct spelling...)

[nightjar]

Very, very cool, Jeff!

My current HMO is partial owner of the only DME they let me use (though that DME has many offices in this area). They'd never let me use cpap.com instead, I know.

That's one of the big reasons we're switching to a different HMO come January 1. The new HMO uses various DMEs, I think, and one is for all things related to sleep disorders. My hope is that they'll be as good as I think they will--I have pretty high expectations, but anything will be better than dealing with the current DME.

Sure would be nice to have cpap.com as an official, recognized option, though.

Anyway . . . congrats, Jeff!

nath

[jnk]

Well, I should clarify so I don't mislead anyone.

First, I am not using Medicare, I only used their publicly-availabe allowable replacement schedule as an example for the purpose of giving my insurance contacts an idea of the schedule I would use. I don't know if it is possible to do what I am doing if you actually use Medicare. (I would think that if it was possible, Slinky would already be doing it! ) I'm sure it is complicated when Medicare pays part and other insurance pays part.

Second, because of the nature of what I do, I do not deal directly with any actual insurance-company employees, only with contacts where I work who then deal with the insurance people. For that matter, for all I know, we may be partly self-insured; I am insulated from some of the nuts and bolts of it all. But I do know that making the case with my contacts of how bad a job the DME was doing was very easy, since the DME had botched every contact I ever had with them. And I know that when my contacts saw my estimate that I would be spending less than $400 this coming year on all pap-related supplies, that got their attention very fast!

Third, none of this was my idea. I got the idea from these statements in the FAQ section at cpap.com:

Will my insurance company reimburse my online cash purchase?

Yes, in most cases. However, reimbursement is an agreement between you and your insurance company. If you are planning on attempting to collect reimbursement, be sure to check with your insurance company first!

https://www.cpap.com is a cash based, high volume, direct to patient business model. We avoid dealing directly with insurance companies and pass the resulting savings to our customers.

However, we do provide our customers with an insurance compliant, itemized invoice that contains applicable insurance billing code(s) for each item purchased.

Additionally, cpaptalk.com is a good resource for those with questions about reimbursement as many cpaptalk.com users regularly purchase from cpap.com and obtain reimbursement from their private insurance companies.

--https://www.cpap.com/cpap-faq/Insurance.html#104

I know this post may sound like one big advertisement for cpap.com, and I admit I like them so far, but I feel my loyalty is to my insurance-contact people, and that will motivate me to look for the best price. Hopefully cpap.com will always have the best price, or will continue to price-match.

With the way the economy is going, I would think that making a similar case to insurance people may not be all that hard for anyone soon. So I encourage everyone to give it a try. What have you got to lose? The worst that can happen is that someone will say "no" and you'll be right where you are now.

Hope that helps clarify.

jeff

[Songbird]

That's wonderful news, Jeff!! If I gave you a phone number, do you think you could call my insurance company and be me just long enough to convince them to do the same thing? My voice is kind of low anyway, and with your talents, I know you could do it.

Marsha

[jnk]

That's wonderful news, Jeff!! If I gave you a phone number, do you think you could call my insurance company and be me just long enough to convince them to do the same thing? My voice is kind of low anyway, and with your talents, I know you could do it.

Marsha

Sure, I'll do it, if you're still speaking to me after you read my post in Eric's thread.

[echo]

WTG Jeff. You HAVE now officially turned to the dark(er) side.

[rested gal]

That's great news for you, Jeff.

I think Den (Wulfman) was able to do something kind'a like that. As I understand it, it's not the same as the way yours is set up -- he has to pay out of pocket when he makes his purchases from cpap.com, and then gets reimbursed later by his insurance.
viewtopic/p296747/viewtopic.php?p=296724#p296724

[txnative]

My insurance works the same way. I purchase the item out of pocket and then submit the receipt to Aetna and get the $ back in about 1.5 months.
My policy is unique in that it pays 100% even for out of network charges which is different from most policies.

[Slinky]

Ha! They pay outta network 100% and STILL get by cheaper than paying in network w/the locals!!!! Now THERE is a lesson for the insurance companies! Duh!